The Lancet – “Benefits and risks of homoeopathy”

November 16th, 2007 by Ben Goldacre in bad science, homeopathy | 83 Comments »

This is a piece I wrote in today’s edition of The Lancet. You can also see this article there in a nice Lancet PDF, along with a “world report” on homeopathy, and the references in pleasantly accessible Crossref format. To be honest, it almost feels silly writing about homeopathy in the Lancet.

“Benefits and risks of homoeopathy”

www.thelancet.com/journals/lancet/article/PIIS0140673607617061/fulltext

Five large meta-analyses of homoeopathy trials have
been done. All have had the same result: after excluding
methodologically inadequate trials and accounting for
publication bias, homoeopathy produced no statistically
significant benefit over placebo.[1–5] And yet homoeopathy
can still be clinically useful.

During the cholera epidemic in the 19th century,
death rates at the London Homoeopathic Hospital
were three times lower than those at the Middlesex
Hospital.[6] The reason for homoeopathy’s success in this
epidemic is even more interesting than the placebo
effect. At the time, nobody could treat cholera, and
while medical treatments such as blood-letting were
actively harmful, the homoeopaths’ treatments were at
least inert.

Similarly, modern medicine can offer little for conditions
such as many types of back pain, stress at work, medically
unexplained fatigue, and most common colds. Going
through a theatre of medical treatment, and trying every
drug in the book, will only elicit side-effects. An inert pill
in these circumstances seems a sensible option.

However, just as homoeopathy has unexpected
benefits, so it can have unexpected side-effects. The very
act of prescribing a pill carries its own risks: medicalisation,
reinforcement of counterproductive illness behaviours,
and promotion of the idea that a pill is an appropriate
response to a social problem, or a modest viral illness.
Similarly, when a health-care practitioner of any
description prescribes a pill which they know is no more
effective than placebo—without disclosing that fact to

their patient—then they disregard both informed consent
and their patient’s autonomy. Some could argue that this
cost is acceptable, but such old-fashioned paternalism can
ultimately undermine the doctor–patient relationship.

There are also more concrete harms. A routine feature
of homoeopaths’ marketing practices is to denigrate
mainstream medicine. One study found that half of all
homoeopaths who were approached advised patients
against the measles, mumps, and rubella vaccine for
their children.[7] A television news investigation found
that almost all homoeopaths who were approached
recommended ineffective homoeopathic prophylaxis for
malaria, undermined medical prophylaxis, and did not
even give simple advice on bite prevention.[8] Undermining
medicine is a wise commercial decision for homoeopaths,
because survey data show that a disappointing experience
with mainstream medicine is one of the few features
to regularly correlate with a decision to use alternative
therapies. But it might not be a responsible choice.

Homoeopaths can undermine public-health campaigns;
leave their patients exposed to fatal diseases; and, in the
extreme, miss or disregard fatal diagnoses. There have
also been cases of patients who died after medically
trained homoeopaths advised them to stop medical
treatments for serious medical conditions.[9,10]

All these problems have been exacerbated by
society’s eagerness to endorse the healing claims of
homoeopaths, and by the lack of a culture of critical
self-appraisal in alternative medicine. Publication bias
in alternative therapy journals is high: in 2000, only 5%
of studies published in complementary or alternative
health journals were negative.[11] To my knowledge, the
ethical issues of autonomy and placebo have never been
discussed. Homoeopaths routinely respond to negative
meta-analyses by cherry-picking positive studies. An
observational study,[12] which amounts to little more than a
customer-satisfaction survey, has been promoted[13] as if it
trumps a string of randomised trials.

Homoeopaths can misrepresent scientific evidence
freely to an unsuspecting and scientifically illiterate public,
but in doing so they undermine the public understanding
of what it means to have an evidence base for a treatment.
This approach seems particularly egregious when
academics are working harder than ever to engage the
wider public in a genuine understanding of research,14 and
when most good doctors try to educate and involve their
patients in the selection of treatment options.

Every criticism I have made could be managed
with clear and open discussion of the problems.
But homoeopaths have walled themselves off from
academic medicine, and critique has been all too often
met with avoidance rather than argument. The Society
of Homeopaths (in Europe) has even threatened to sue
bloggers,[15] and the university courses on alternative
medicine which I and others have approached have flatly
refused to provide basic information, such as what they
teach and how.[16] It is hard to think of anything more
unhealthy.

To ban homoeopathy would be an over-reaction, as
placebos could have a clinical role. However, whether the
placebo effect is best harnessed by homoeopaths will
remain questionable until these ethical issues and sideeffects
have been addressed.

Ben Goldacre
The Guardian, London EC1R 3ER, UK
ben@badscience.net

I am a medical doctor who is also employed by the media as a commentator on pseudoscience and the sociology of medicine.

1 Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homoeopathy. BMJ 1991;
302: 316–23.

2 Boissel JP, Cucherat M, Haugh M, Gauthier E. Critical literature review on the
effectiveness of homoeopathy: overview of data from homoeopathic
medicine trials. Brussels, Belgium: Homoeopathic Medicine Research Group.
Report to the European Commission. 1996: 195–210.

3 Linde K, Melchart D. Randomized controlled trials of individualized
homeopathy: a state-of-the-art review. J Alter Complement Med 1998;
4: 371–88.

4 Cucherat M, Haugh MC, Gooch M, Boissel JP. Evidence of clinical efficacy of
homeopathy: a meta-analysis of clinical trials. Eur J Clin Pharmacol 2000;
56: 27–33.

5 Shang A, Huwiler-Müntener K, Nartey L, et al. Are the clinical effects of
homoeopathy placebo effects? Comparative study of placebo-controlled
trials of homoeopathy and allopathy. Lancet 2005; 366: 726–32.

6 Hempel S. The medical detective. London, UK: Granta Books, 2006.

7 Schmidt K, Ernst E. Aspects of MMR. BMJ 2002; 325: 597.

8 Jones M. Malaria advice ‘risks lives’. Newsnight, BBC2 July 13, 2006. news.
bbc.co.uk/1/hi/programmes/newsnight/5178122.stm (accessed Nov 8, 2007).

9 General Medical Council Fitness To Practise Panel. Dr Marisa Viegas. 2007.

www.gmc-uk.org/concerns/hearings_and_decisions/ftp/20070628_

ftp_panel_viegas.asp (accessed Nov 8, 2007).

10 Sheldon T. Dutch doctor struck off for alternative care of actor dying of cancer.
BMJ 2007; 335: 13.

11 Schmidt K, Pittler M, Ernst E. Bias in alternative medicine is still rife but is
diminishing. BMJ 2001; 323: 1071.

12 Spence DS, Thompson EA, Barron SJ. Homeopathic treatment for
chronic disease: a 6-year, university-hospital outpatient observational
study. J Altern Complement Med 2005; 11: 793–98.

13 Grice E. Keep taking the arsenic. Daily Telegraph Nov 25, 2005.

www.telegraph.co.uk/health/main.jhtml?view=DETAILS&grid=

P8&xml=/health/2005/11/25/hhomeo25.xml (accessed Nov 8, 2007).

14 Evans I, Thornton H, Chalmers I. Testing treatments: better research for better
healthcare. London, UK: British Library, 2006.

15 Goldacre B. Threats, the homeopathic panacea. Guardian Oct 20, 2007.
www.guardian.co.uk/science/2007/oct/20/homeopathy (accessed
Nov 6, 2007).

16 Giles J. Degrees in homeopathy slated as unscientific. Nature 2007;
446: 352–53.

 


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83 Responses



  1. trujiman said,

    November 16, 2007 at 8:57 am

    Excellent article, but I am slightly disappointed you didn’t get any major swearing in this time. I hope you are not losing your edge.

  2. manigen said,

    November 16, 2007 at 10:23 am

    So homeopathy isn’t a swearword then?

  3. emilypk said,

    November 16, 2007 at 2:10 pm

    The dilemma is interesting when placebo is the only effective treatment we have, should it be used? It does involve a degree of deception but in many cases both the patient and doctor hold to that view anyway.

  4. pv said,

    November 16, 2007 at 3:06 pm

    Surely once the element of deception is dispelled then the placebo loses most of its value, most of its effect. All the homeopath does is manage the deception and harvest the not inconsiderable profit.

    Also, isn’t there an ethical problem with the profit on the primary tools of the homeopathy business; i.e. plain water and sugar pills. The actual production costs are restricted to the price of water, sugar, alcohol and packaging. There’s no active ingredient or research involved, so no expense there. The cost to the consumer represents nearly all profit to the homeopath and manufacturer. It’s not even as if one is paying for any useful or hard won expertise, unless you count deception as a skill worth paying for.

    Another way of looking at the “unexpected” effect of homeopathy would be to say that it satisfies a demand – sort of. The demand for an action, that is. It “sort of” satisfies only because it doesn’t dissatisfy in the negative sense of giving unwanted side-effects. Rather they are benign. And where the problem or ailment is self limiting, benign is good. But it’s still a form of self-deception.

  5. Girl Friday said,

    November 16, 2007 at 3:08 pm

    This is fantastic. Also very useful as I was just writing to the University of Central Lancashire (where I did my journalism training back in the dark ages when it was a poly) asking how they can justify their homeopathy MSc. So now it’s a referenced letter.

  6. rnewson said,

    November 16, 2007 at 4:41 pm

    I noticed that there is a UK petition to remove NHS funding for this nonsense, not many votes :(

    petitions.pm.gov.uk/anti-homeopathy/

  7. syslinkdown said,

    November 16, 2007 at 6:23 pm

    I guess another thing I would worry about with this whole homeopathy-(or anything, really)-as-a-condoned-placebo thing is that it’s might end up contributing to stagnation of research for certain issues. It seems we’d have to decide which things can or cannot (should or should not?) be treated with placebo… and once something has been tossed into the ‘placebo’ pile, are people going to be less likely to look for real answers? Isn’t it kind of antithetical to medical science to decide something can’t be treated, or has no explanation?

    I don’t know: it just seems likely to introduce a kind of laxness into the process, a kind of easy out.

  8. emilypk said,

    November 16, 2007 at 8:52 pm

    I think putting them in the ‘placebo’ pile actually would encourage research by making it clear that we don’t have actual mechanism-based treatments available.

  9. helenlff said,

    November 16, 2007 at 11:13 pm

    If only it were just a question of whether to give placebos to malingering Europeans. The Abha Light Foundation is only one of several organisations in Africa raising money from charities in the Uk to promote homeopathy as a remedy for Aids, malaria and other killer diseases. In India, many villages are only served by homeopaths, treating everything from heatstroke to breast cancer. Vulnerable populations all over the world are being exposed to quacks who can point to a respectable science degree from a UK university framed on their wall. How can a vulnerable patient in a remote area understand that a British university would give a science degree to a quack? I can barely understand it myself. What am I saying? I cannot understand it at all. This is a matter of life and death. Nail them.

  10. pv said,

    November 17, 2007 at 12:04 am

    Vulnerable populations all over the world are being exposed to quacks who can point to a respectable science degree from a UK university framed on their wall. How can a vulnerable patient in a remote area understand that a British university would give a science degree to a quack?

    They can’t, obviously. This is why it is so deplorable that British Universities are allowed to run degree courses on quackery such as homeopathy. “There’s a demand” they say. “Demand” my arse. They do it because it is likely to be profitable and to hell with the consequences. A degree course in homeopathy has no educative value whatsoever. It is anti-science, anti-critical-thinking, anti-logic and it’s a despicable thing to do.

  11. helenlff said,

    November 17, 2007 at 1:57 pm

    To practice Western quackery on vulnerable populations is tantamount to murder, and British universites have their share of blood on their hands by condoning quackery and calling it science. Has there been a letter to UK university chancellors in the same way as there has been a letter to written to the NHS trusts?

  12. David / Homeopathy Zone said,

    November 18, 2007 at 9:13 am

    Misinterpretation of homeopathy research

    This is a well-reasoned article but one that’s based on an oft-repeated prevarication of the state and implications of research in homeopathy.

    Specifically, the claim that according to the 5 referenced meta-analyses “after excluding methodologically inadequate trials and accounting for publication bias, homoeopathy produced no statistically
    significant benefit over placebo” is contrary to the conclusions of at least one of these meta-analyses.

    Allow me to supply an evidence base:

    Linde et al. conclude that “[t]he results of our meta-analysis are not compatible with the hypothesis that teh clinical effects of homoeopahty are completely due to placebo. However, we found insufficient evidence from these sudies that homoeopathy is clearly efficacious for any single clinical condision. Further research on homoeopathy is warranted provided it is rigorous and systematic.”

    Elsewhere in the paper they state that “a serious effort to research homoeopathy is clearly warranted despite its implausibility.”

    While their claims are dismissive of the present clinical relevance of the results, they are quite conclusive about the statistical relevance of the results — directly contradicting this article’s main empirical premise — as well as about the viability of a research programme into homeopathy.

    When The Lancet repeatedly has to bend the evidence, and when it turns to relying on a substandard meta-analysis that egregiously and inexplicably omits mention of the studies on which its conclusions are based (Shang et al., where the subset of studies on which the statistical analysis was done was not disclosed), it hurts the credibility of EBM first and foremost.

    Allow me to quote from Shang et al.: “The methodological quality of randomised trials cannot be reliably assessed from published articles because reporting on important features of the methods is incomplete in many cases.” Hypocrisy knows no shame!

    Homeopathy in cholera

    What a facile dismissal of a fascinating epidemiological record covering multiple hospitals in multiple countries which consistently shows a less than 10% mortality rate, and sometimes lower than 5%, from cholera in the mid 19th-century when under homeopathic care!

    Perhaps the 50% mortality rate in conventional hospitals was due to the heroic medicine of a past age, but does untreated cholera carry a mortality rate of under 10%? Evidence, please!

    Or else homeopathy is a phenomenal placebo (there is an evidence base for homeopathy’s clinical effectiveness per se) and it may well be rational to allow or even encourage its widespread use and irrational to oppose doing so.

    Is homeopathy dangerous?

    Homeopathy is dangerous, you say? Indeed it may be, but this claim is based on — Heaven forbid — anecdotal evidence! High-quality trials are indicated before this claim can be supported.

    Are homeopaths dangerous?

    Yes: certain ones. Those who don’t have an adequate sense of both the advantages and limitations of Evidence-Based Medicine. Those who distribute homeopathic remedies indiscriminately for all manner of ailments. Those whose main and only incentive is fincial gain. Those who are scornful and dismissive of their ideological opponents. And so on.

    Yet I fail to see how these qualities are uniquely adherent to homeopaths, unless one were to claim that such qualities in (and only in) scientifically sanctioned individuals are pardonable.

    In conclusion

    The available evidence base doesn’t warrant treating the homeopathic issue with universal disdain, as has become fashionable lately (for those interested, I have a critique of Dawkins’ recent anti-homeopathy TV programme on my blog).

    Rather than bemoaning the public’s turn away from scientific medicine, perhaps scienists ought to consider why it is that medicine is not fulfilling its promise of providing a comprehensive solution to humans’ ailments, and is instead providing solace mostly to hyper-intellectual, hyper-rational individuals who tend to live in disconnection from a part of their being.

    Insofar as medicine has stopped evolving in essence rather than detail, it will be eclipsed by other models of reality, probably ones inferior to it. On the other hand, if homeopathy and other anomalies are taken as challenges to the rigid methodology of contemporary medicine (a methodology, incidentally, which has no evidence base in its support — it is assumed a priori that Evidence-Based methods produce clinically superior health-care) then conventional medicine will benefit regardless of the outcome. And this is just what one of the aforementioned meta-analyses concluded (Linde et al. again):

    “No matter what the end result is for homoeopathy, an investment in such a systematic research stretegy could provide us with a model for the evaluation of other emerging fields of medicine, both complementary and conventional.”

  13. Ben Goldacre said,

    November 18, 2007 at 12:24 pm

    you have cherry picked the one positive meta-analysis, Linde et al from 1997, which gave a final pooled odds ratio: 1·78 with a range of 1·03 to 3·10. (Look at that range. It’s pretty wide, and it very nearly hits “1.0”.). this was borderline at best. as well as barely being significant, when they looked at whether homeopathy was effective for any one single condition, by pooling all the trials for each condition together, they found that homeopathy wasn’t any better than placebo.

    more importantly you fail to mention (since you market yourself as an expert with the evidence i can only assume that this is deliberate cherry picking): that Linde himself re-analysed the same data, properly, once he was actually doing his PhD. this work was published, in 1998, and in this (methodologically more rigorous) updated analysis Linde found that homoepathy performed no better than placebo. Linde is very clear about this disparity.

    it is for this reason that i do not reference Linde’s erroneous 1997 meta-analysis with its well known false positive result.

    given the scale of your misrepresentation of the facts in this regard i’m afraid i can’t really be bothered to go any further with your claims. before you allow yourself to indulge feeling wounded over this, you have to appreciate that homeopaths are now producing a deluge of this kind of material, and it’s too tedious to go through it all, pointing out the simple flaws. it is more a matter of pointing out the systemic problems with the way that evidence is being used by the homeopathy industry more as theatre and marketing flim flam than as evidence, which to my mind is their greatest crime, undermining the public understanding of evidence.

  14. David / Homeopathy Zone said,

    November 18, 2007 at 2:49 pm

    Ben,

    1. I didn’t cherry-pick: The Kleijnen et al. study was caustiously positive (and statistically significant), too, so that’s 2 out of 5 that reached conclusions that differ from your report of them. And I believe that you know in your heart that the Shang et al. study shouldn’t even be brought up as evidence for or against anything, as it fails to reach basic quality and transparency standards.

    I am aware of Linde’s reappraisal of his previous conclusions: I was specifically replying to your claims in my comment. Why did you not chose not to reference that study instead, then, if it was “methodologically more rigorous”? Perhaps to brand an popularly referenced positive study as negative? I also wonder whether subjecting other meta-analyses to a reassessment might not yield similar “changes of heart”: Shall we have a go at Shang et al.?

    The existence of the latter study in no way excuses a misrepresentation of the data of the former. So what if the lower limit of the odds ratio is near unity? It is the lower limit and not the average, which is well above unity, and statistical significance is nevertheless satisfied. If you feel this study doesn’t demonstrate any evidence in favour of homeopathy (since your initial claim is binary: ‘no evidence’ rather than ‘weak evidence at best’) then do produce a comprehensive critique of it, but don’t use it as evidence against homeopathy.

    Moreover, the fact that this study did not reach positive conclusions with regard to any single condition is irrevelant to the primary question that concerns skeptics, namely whether homeopathy could produce any effect in principle. It is disgenuine to fault a study that addresses one of these questions (statistical significance) on the grounds that it doesn’t address the other (clinical relevance), yet I have yet to meet a skeptic (among the ones informed of the relevant research) who doesn’t use this as an argument against positive research conclusions on homeopathy.

    I therefore fail to see where I have misrepresented things, as you claim, to a scale that warrants your not bothering with furthering the discussion.

    2. Regarding the homeopathic industry: I agree with you that there are many problems with it, most of which have to do with the fact that over-the-counter conditions-specific medications (which are not used by the vast majority of classical homeopaths) are big business (and, I will note, classical homeopathy is not big business: it is harder and less financially rewarding than most any other form of medicine). Accordingly, I likely share many of your concerns and would probably reach similar conclusions to yours about how these products should be regulated, as they do definite damage to the image of the profession, and rightly so.

    I believe that if conventional medicine cautiously began viewing these medicines without hostility, that some of the great attributes and achievements of the medical system could be applied also to alternative systems. These might include establishing stricter practitioner
    regulation (at present most people calling themselves homeopaths are actually not, and “homeopathy” is regularly used — often in a slanderous manner by the skeptical community — to refer to all manner of practices that have nothing to do with it), higher quality training, etc. This is where homeopathy lags behind significantly, but this is no strike against it.

    I should make it clear that I don’t expect anyone who hasn’t seen homeopathy work in a clinical setting to believe in it, as its evidence base is in its clinical results which too often defy a simple dismissal as due placebo effect. The research evidence for homeopathy is weak, but this is not surprising in a system of medicine that targets not symptoms but the underlying state causing them, so in everyday chronic-disease practice improvement is seen to be gradual yet holistic rather than quick and symptom-specific. I therefore personally do not use evidence to make any claims beyond the claim that the homeopathic effect has some RCT evidence behind it, evidence which is indeed not relevant to the practice of homeopathy which is in any case not based on matching disease entity to remedy so cannot be helped by RCTs, at least in their present incarnation.

    The proper attitude toward homeopathy by outsiders to it should, in my opinion, be cautious rather than self-assured skepticism. Absent real engagement with the clinical reality of homeopathy (as opposed to armchair skepticism – and homeopathy definitely criticizes the notion that clinical reality can be determined merely through perusal of research papers), the proper scientific stance is agnosticism. I, for one, know many homeopaths who are cautiously rather than self-assuredly critical of conventional medicine, and many of them routinely work with patients on multiple medications and have full respect for the anti-inflammatory wonders of corticosteroids etc. even as they bemoan their use as ultimately destrcutive to the system (which, incidentally, medical doctors would be in agreement about).

    I believe that this change of attitude by mainstream medicine would open the door to specific problematic practices within the homeopathy industry broadly speaking being addressed by both sides working together. An assault on homeopathy, on the other hand, would at best yield a Pyrrhic victory to our society.

  15. Ben Goldacre said,

    November 18, 2007 at 5:37 pm

    you state that 2 of the 5 meta-analyses differ from my account of them. you do not say which. at best you could differ in interpretation of kleijnen. if i remember correctly there are in fact 12 negative systematic reviews/meta-a’s, but i specifically chose to reference only those 5 on this occasion, for reasons of space mainly (only allowed 12 refs in total for a lancet commentary, i stretched it to 16), but also comedy, the punchline of which will become clear at some stage in the months to come.

    more interestingly, if you wish to have a discussion about the ethical and cultural problems in homeopathy then that would be much more interesting: it would also be, with the greatest respect, i suspect,a first in your profession.

    since you are evidently familiar with the literature, i’d be very grateful for your help.

    are you aware of any references to papers in whcih homeopaths are critical of their own practise, or ethics, or evidence base, in the homeopathic academic literature?

    literally anything, anywhere, would be great to see.

  16. BSM said,

    November 18, 2007 at 10:17 pm

    David / Homeopathy Zone

    By engaging in discussion with Ben over the merits of the various meta-analyses of trials of homeopathy you are implicitly accepting the valid applicability of ordinary controlled trial methods to homeopathy.

    So, what do you say to those homeopaths and homeopathic organisations who give every appearance of being charlatans and quacks by claiming that homeopathy is in some way beyond the reach of controlled trials

    www.homeopathy-soh.org/whats-new/press-releases.aspx

    and who repeatedly promote customer satisfaction surveys of homeopathic patients as if they have anything to say about the central claims of homeopathy itself

    www.badscience.net/?p=188

    As someone who clearly believes that good experimental methods should be used to test homeopathy I am sure that such evasions, misdirections and misrepresentations must cause you considerable distress.

    It is your clear professional duty to take a stand against these unethical activities. Will you?

  17. Ben Goldacre said,

    November 18, 2007 at 10:22 pm

    that’s a really interesting suggestion. is there any discussion within homeopathy where some homeopaths challenge other homeopaths over their assertion that trials are unacceptable? or is challenging ideas always interpreted by homeopaths as being an emotional attack?

  18. superburger said,

    November 19, 2007 at 11:14 am

    hey david,

    it seems that you agree that the claims of homeopathy can be tested by scientific methods. I

    If that’s true, can you describe, roughly, an experiment that *would* convince you that the effects of homeopathy are a placebo response?

    if homeopathy’s claims are true, then there must exist such an experiment and a result.

  19. JQH said,

    November 19, 2007 at 11:17 am

    helenlff – agreed

    There’s also a bunch of deluded quacks pushing homeopathy in Botswana. Blogged about it on jaycueaitch.wordpress.com/

    Blatant plug, I know. The Maun Clinic involved is a registered charity here in the UK.

  20. childermass said,

    November 19, 2007 at 11:26 am

    “is there any discussion within homeopathy where some homeopaths challenge other homeopaths over their assertion that trials are unacceptable?”

    See www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=11055777&dopt=Citation

  21. David / Homeopathy Zone said,

    November 19, 2007 at 3:26 pm

    superburger,

    If that’s true, can you describe, roughly, an experiment that *would* convince you that the effects of homeopathy are a placebo response?

    Such big questions cannot be determined through single experiments, so my answer is a definite “No”. The days of simple logical-positivism are long over in philosophy of science; for some reason they linger on in the medical sciences. I would have to consider my clinical evidence for one, and would call it absurd if medical doctors claimed they couldn’t rely on their clinical evidence but acted as mere dispensers of previously approved medications.

    I cannot offer any explanation for how homeopathy works, but when scientists do research in this area skeptics, again, want a clearcut explanation even though the simplest explanation would have to give several mechanisms (transmission of information into water; preservation of information in water over time; transmission within the body; ultimate effect on cells/tissues/etc.), hinting at the complexity of the issue. At best, positive results of some sort are greeted with “Yes, but this still doesn’t prove that [some other part of the chain of causlity] can happen” — which is a miunderstanding of scientific process (consider the field of theoretical physics which is rife with theories unproven or unprovable — incidentally I have found based on a small sample that theoretical physicists often have no issue with the implausibility of homeopathy).

    Regarding empirical evidence, I should point out that the medical community hasn’t presented any such experimental proposals to the homeopathic community, and when high-quality RCTs such as:

    Reilly D, Taylor MA, Beattie NGM et al. Is evidence for homoeopathy reproducible? Lancet 1994; 344: 1601-1606.[PubMed] (I haven’t seen a criticism of this study, other than a recent personal enounter with “Yes, but at 13 years old it is out-of-date”)

    are presented as evidence they are thwarted in various ways, revealing the fact that the medical community itself doesn’t treat RCTs as crucial evidence but as part of a complex decision-making process.

    The point I made in my last comment about skeptics wishing for a simple answer, even when there isn’t one, stands. Even the available unimpressive evidence base in favour of homeopathy, and despite methodological concerns with RCTs’ applicability to homeopathy, doesn’t line up neatly with the placebo hypothesis.

    The latest fashion, since the Shang et al. study, is to proclaim that higher quality studies show smaller effects (even when the same trend is seen in conventional medicine studies by their own admission), and now people the world over extrapolate gratuitously to the claim that high-enough quality studies show no effect (and that any positive studies therefore must be sub-standard — yet another unwarranted extrapolation).

    I am still waiting for Shang et al. to publish the list of their highest-quality studies so that their claim could be addressed, as so far theirs has been rhetoric devoid of substance yet has been hailed far and wide as the death blow to homeopathy. This is one unimpressive death blow indeed! If homeopathy were so clearly and utterly nonsense there would be no need for so much kneading of the evidence in attempt to dissolve it to irrelevance.

  22. BSM said,

    November 19, 2007 at 5:57 pm

    David,

    Ah, ha. That’s called the ‘trying to have it both ways’ defence. A ploy frequently used. Sort of accept the validity of trials but keep emphasising anecdotal experience as if it is a legitimate substitute without ever quite saying so explicitly.

    “would call it absurd if medical doctors claimed they couldn’t rely on their clinical evidence but acted as mere dispensers of previously approved medications.”

    But you would like to replace RCTs with only that clinical evidence. It would be idiotic to say that doctors do not use clinical evidence and experience. However, they know it is a ‘next best’ and a compromise to be used when no better information is available. They are also extrapolating from a foundation of controlled data so they have a fair chance of being right when they make their clinical judgements.

    Homeopaths have no such foundation.

    Let’s try to advance the debate a little with some small steps and simple questions.

    If I took away from you all your homeopathic remedies in either pill or liquid form (or indeed any of the various alternative remedy media that some homeopaths use instead) would that prevent you from applying homeopathy to your patients?

    If I allow you access to your homeopathic remedies in either pill or liquid form does that permit you to apply homeopathy to your patients?

    Indeed, with your pills and liquid remedies are you a homeopath, without them are you a counsellor instead?

    I’d be grateful for specific answers.

  23. helenlff said,

    November 19, 2007 at 9:24 pm

    David, Can I ask another very small specific question? If I bruise myself and I buy homeopathic arnica from a pharmacy by myself, without going to a homeopath, do you think it could heal my bruise?

  24. Amazon1954 said,

    November 20, 2007 at 10:31 am

    Ben In answer to 23 from a homeopath:
    This question shows a lack of understanding of Homeopathic parameters. See Lionel Milgrom on this subject – assessing homeopathy by the same parameters as biomedicine.
    What I would like is for you to come to an understanding as to why this question is relevant to biomedicine but not to homeopathic medicine. I would happily discuss this with you.
    I have often criticised the homeopathic literature, but I must admit to not having done this publicly. We should praise where appropriate and similarly condemn where indicated.
    There are estimated to be over 3,000 homeopaths in UK, but what is a homeopath? As David says all manner of interpretation of homeopathic practice is called collectively homeopathy. Many of these interpretations have nothing to do with genuine homeopathy.I would be happy for these ‘mongrels’ (vide Dr JT Kent)to call themselves what they like, but why do they insist on carrying on such dubious practices under the label of homeopathy?
    Lastly, but perhaps this is too inflammatory, would you be willing to do a trial yourself of a homeopathic potency?
    Thank you for your time.

  25. Bass Tyrrell said,

    November 20, 2007 at 2:33 pm

    David / Homoeopathy Zone writes:

    “I cannot offer any explanation for how homeopathy works, but when scientists do research in this area skeptics, again, want a clearcut explanation even though the simplest explanation would have to give several mechanisms (transmission of information into water; preservation of information in water over time; transmission within the body; ultimate effect on cells/tissues/etc.),…” No David, this is a straw man argument. Sceptics in general want you to demonstrate an effect, the mechanism would be a matter for research after that event. The situation at present is that the evidence shows no benefits over and above the placebo effect. Therefore there is no need for complex explanations of mechanisms involving the memory of water. Who, on this board, has demanded such an explanation?

    A really interesting area of research of course is how and under what conditions the mere fact of treatment triggers an improvement in the subject; how this effect varies according to the type of treatment offered, to the amount of counselling given, to the apparent seriousness of the treatment (as Ben points out, better effects come from injections of salt water than from a placebo pill) and all sorts of areas around this. If homoeopaths could ever break away from the 18th century and join us in the twenty-first, this would be a great research field for them.

  26. markgdavis said,

    November 21, 2007 at 11:17 am

    I don’t mean to offend anyone, but I’ve read double blinded, randomized trials that show efficacy for homeopathy (cited below). Reading those has made me lean towards believing that homeopathy works. Are there good RCTs that don’t show homeopathy to be more effective than placebo? Because I haven’t read them, and I would very much like to. Also, I checked out the abstracts for some of those meta-analyses cited above, and it seems that Linde, Kleijnen and Boissel find homeopathy to be more effective than placebo, so I’m confused about how they indicate that “homoeopathy produced no statistically significant benefit over placebo.” I’d love a response, I’m not sold that homeopathy works, it just seems that experimental evidence indicates that it does.

    RCTs I’ve read that show efficacy for homeopathy include:
    Jacobs et al, “Treatment of Acute Childhood Diarrhea with Homeopathic Medicine: A Randomized Clinical Trial in Nicaragua,” Pediatrics, Volume 93, Number 5, pp. 714-725 (May 1994)
    Jacobs et al., “Homeopathic Treatment of Acute Childhood Diarrhea: Results from a Clinical Trial in Nepal,” Journal of Alternative and Complementary Medicine, Volume 6, pp. 131-139 (2000)
    Gibson et al., “Homoeopathic Therapy in Rheumatoid Arthritis: Evaluation by Double-Blind Clinical Therapeutic Trial,” British Journal of Clinical Pharmacology, 9, pp. 453-459 (1980)
    Taylor et al., “Randomised controlled trial of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series,” British Medical Journal, 321, pp. 471-476 (19 August 2000)

  27. Harlequin said,

    November 21, 2007 at 1:28 pm

    When Shang et al did a metaanalysis of 110 homeopathy trials, homeopathy was significantly better than placebo. When they restricted it to high quality trials (n=20), homeopathy was significantly better than placebo. They then restricted it to large, high quality trials (n=8), and claimed they were no better than placebo. Does anyone here know which 8 homeopathy RCTs were selected?

  28. Jojoba's witness said,

    November 21, 2007 at 2:07 pm

    My God, this is depressing.

    Yesterday I came across an elderly person (I will be as unspecific as I can for reasons of confidentiality), who is pretty healthy for their years. Forty or more years ago (s)he felt run down; the NHS doctor wasn’t much help, so a homeopath was consulted.

    The history made the diagnosis absolutely clear: food intolerance. The homeopath went on to prove this by assembling a variety of food samples and placing them on the patient’s tongue, one at a time. For each sample he tested the strength in the patient’s right arm: if the arm could be flexed against his resistance then the strength of the biceps was clearly unimpaired by the food sample on the tongue; if the arm gave way, the sample was evidently weakening the patient. In this way he was able to construct a (admittedly highly restrictive) diet sheet to which the patient has strictly adhered, and has remained in good health.

    Occasionally (s)he yields to the urge to eat a proscribed food, and it immediately causes a transient but profound malaise. It is not clear (it was so long ago) whether the advice was backed up by homeopathic preparations, but if it was, the patient has long since stopped taking them: the advice seems to be the key.

    This exemplifies the principles of good scientific homeopathy: regardless of the mechanisms that might or might not be involved, the homeopath tested the food samples against a measurable end-point. He gave advice based on those observations, and the patient has remained well as long as the advice is adhered to.

    This seems more evidence-based than advice given to prevent people having MMR vaccines or taking heart pills, and, apart from the initial consultation fee, I can’t see that the homeopath has gained materially from this encounter.

    All I can say is, if you don’t find this convincing you must have had a scientific education.

    Eh?

    Yup: didn’t the homeopath use a surrogate – not a real – end-point? And can we be sure that he applied a standard resistance to the patient’s elbow flexion with every food sample? Did he make the measurements ‘blind’?

    Or could it possibly be that the patient was tricked into believing that this huge variety of foods is bad for them, to the extent that unpleasant symptoms are experienced decades after the consultation? Was it coincidence that the homeopath had the food samples ready: it couldn’t be that he told every patient that they had food intolerance, whatever their symptoms, could it?

    All I know is that the power of the consultation bestowed more than half a lifetime of misery on an individual who yearns to enjoy a succulent steak, or a normal meal with friends, or a glass of good wine. And the misery continues.

    OK, that’s an n of 1, but it reinforces my long-held impression of how the ignorant (i.e. those uneducated in scientific principles) and the credulous are preyed upon by these clever parasites who justify their sorry trade by finding a tiny chink in the armour of overwhelming adverse evidence and bringing all their specious arguments to bear on it. To say, ‘So what if the lower limit of the odds ratio is near unity? It is the lower limit and not the average, which is well above unity’, reveals a hopeless (deliberate?) lack of understanding of statistics: no conventional drug would ever be licensed on that evidence.

    So what is the homeopath’s payoff? It’s being believed.

  29. David / Homeopathy Zone said,

    November 22, 2007 at 10:40 am

    BSM,

    Of course I would like to have it both ways, accepting the validity both of trials and of ancedotal evidence: I am trying to make this very point, that both sources of evidence are useful. I am also making the further claim that when the clinical reality is unambiguous it shouldn’t be trumped by RCTs which, I repeat, have never been shown ultimately to produce better clinical outcomes (it is assumed that they do because they axiomatically serve as the yardstick). It is not clear to me, for example, that in the autism & vaccination debate controlled studies should trump clinical reports on the matter, especially considering how studies on homeopathy are subject to free independention right on the authoritative pages of The Lancet.

    Without pills and drops homeopaths would indeed be like counsellors, effective to the extent they are able to influence the patient through their persona and other such placebo avenues.

    Bass Tyrrell,

    Multiple high-quality studies have shown that some homeopathic effect exists (not necessarily useful results for clinical application, but ones that show that the effect is real). That you ignore them suggests to me either that you haven’t read them or are unqualified to do so, or that you are applying the maxim that “extraordinary claims require extraordinary proof”, in which case you are implicitly demanding mechanistic explanation.

    So, between your ignorance of the data, your logical inconsistency, and the fact that you believe that I am an 18th-century relic (when short on evidence, simply time-shift your adversary!), I find my hands tied.

    Harlequin,

    Don’t rock the boat! The value of the Shang et al. study is that it offers irrefutable evidence against homeopathy! For the authors to reveal these studies would be a gross inconsistency indeed, as the evidence would become refutable-in-principle!

    Jojoba’s witness

    What you are describing is kinesiological testing with homeopathic preparations, not homeopathy and certainly not classical homeopathy. The effect seen under muscle testing is definitely real in my experience as both tester and testee, but I have yet to see anything close to a consistent method of interpreting the evidence, and I don’t know (and haven’t investigated) whether the effect itself is consistent over time. What I see intead is that every pracitioner has a unique way of interpreting the results, and that suggestions are either commonsensical or shoddy. So I don’t take this technique seriously, and in any case, the anecdote is irrelevant to our point because it doesn’t concern homeopathy.

    Regarding your claim that no drug would be licensed on marginal evidence, I’d like to see evidence that this is so, as technically the meta-analysis passed the criteria established by medical science itself. Besides, licensing of medications also takes into consideration side-effects and litigation issues, beyond pure statistical ones. It is a myth that RCTs are used merely to determine efficacy, and their historical rise to prominence is closely tied to the issue of providing objective evidence of efficacy given the presence of adverse reactions, as a way of protecting clinicians and the medical system at large from criticism and possible litigation.

    Moreover, if you consider the Linde et al. evidence statistically marginal, this still is very far for claiming it as evidence against homeopathy, or as not even weak or provisional evidence for homeopathy, as is repeatedly being done here.

    Finally, if you look at Shang et al. you will see results which are hardly decisive (even though they are statistically significant), leaving aside any faults with the study for the moment. Given this, the deafening silence in the skeptical community about this and the other faults in the study is both distressing and damning.

  30. wilsontown said,

    November 22, 2007 at 11:17 am

    Re: the Shang et al. meta-analysis. The 8 homeopathy trials and 6 conventional trials that were considered to be large, high quality trials are identified by the authors in their reply to comments on the original article. See Lancet 366 (2005); p. 2083. The list of included trials can be found as an appendix to the online version of the original article, see Lancet 366 (2005); 726-732.

  31. Fralen said,

    November 22, 2007 at 11:26 am

    How fascinating, I’d always taken homeopaths at their word when they said that Shang et al had refused to reveal the trials that were identified as the highest quality, and thought that was a little odd. I should have checked. In fact as you say they do clearly identify them the moment the issue is raised.

    This really does just go to show – yet again – that you simply cannot trust a single word that homeopaths say. To anyone who works in any field of academia this level of wilful and unending misrepresentation on every tiny factoid is exhausting but also truly remarkable!

    linkinghub.elsevier.com/retrieve/pii/S0140673605678816

    We agree that the larger trials of higher methodological quality (references 46, 55, 71, 80, 84, 94, 96, 97 in webappendix 1 and 23, 25, 45, 53, 66, 72 in webappendix 2) should have been identified, and are grateful for the opportunity to rectify this oversight. Our study was not a standard meta-analysis of Cochrane reviews, which are typically based on fewer than 10 trials,2 but a large comparative study of 110trials of placebo-controlled trials of homoeopathy and 110 carefully matched trials of conventional medicine. In this situation it is difficult to report on every variable that may be of interest. This is also illustrated by Linde and colleagues’ 1997 article,1 which included 89 homoeopathy trials. Linde and colleagues failed to identify the trials that were adequately concealed, the trials that reported predefined outcome measures, or the five trials that they included in a “worst case” scenario (high methodological quality, indexed in MEDLINE, higher dilution).

  32. Bass Tyrrell said,

    November 22, 2007 at 5:00 pm

    David / Homeopathy Zone: touch a nerve did I? Maybe you would cite the trials in the area that you regard as high-quality that you base your analysis on – then I can tell you whether I am familiar with them or not. I am sure you wouldn’t dream of cherry picking only studies that support your PoV now would you? I am sure I am not familiar with every single study on the subject – but do remember we are talking about the overall evidence.

    Yes, extraordinary claims require extraordinary proof, but to claim that that implicitly implies requiring a mechanism is simply fallacious. It simply requires clear proof of an effect. Science is full of measurable effects that have yet to be explained.

    You state “It is not clear to me, for example, that in the autism & vaccination debate controlled studies should trump clinical reports on the matter,”. This is really worrying because it shows breathtaking ignorance of the difference between correlation and causation. A clinical report can only report correlation: vaccination happened on day X, parents report symptoms on day Y, diagnosis is made on day Z. The clinical report cannot say what would have happened had no vaccination taken place. This is why controlled studies are needed. If the incidence of autism is the same in children who are vaccinated as in children who are not vaccinated then the conclusion is absolutely clear,

  33. BSM said,

    November 22, 2007 at 6:40 pm

    David said;

    “Without pills and drops homeopaths would indeed be like counsellors, effective to the extent they are able to influence the patient through their persona and other such placebo avenues.”

    And, should your pills have genuine effects, but I swapped them from ‘blanks’ that would leave you as solely a counsellor and the vital extra component that you believe homeopathy supplies would be absent.

    Fine. So that keeps homeopathy well within the range of things that can be perfectly properly tested by randomised controlled trial.

    Perhaps you could perform your public duty and explain to homeopaths like Amazon1954 that homeopathy is just as well-behaved under trial as any other hypothesis.

    That, would be fine, except that you go on to say something really really stupid;

    “I am also making the further claim that when the clinical reality is unambiguous it shouldn’t be trumped by RCT”

    In other words, all the trials are negative, but I take a pill and my personal headache goes away so the pill must have worked.

    Define for me an unambiguous clinical reality. Clue: you can’t. There is no such thing. This is another fantasy created by people trying to defend ineffective therapies.

  34. David / Homeopathy Zone said,

    November 23, 2007 at 1:20 pm

    Fralen,

    I am glad that the authors finally did disclose their data, and recant my criticism accordingly. I will point out, however, that they did not do so “the moment the issue was raised” but presumably after much pressure (which mounted immediately upon publication) and in reply to several critical letters published in that week’s journal: the original publication date was August 27, 2005, and their relevant reply on December 17, 2005 — well after the paper had had its major political impact on the homeopathy debate. (That I haven’t been alerted to this reply to date suggests to me that I am not alone in my ignorance of it.)

    Furthermore, there’s no need to conclude that nothing I say can be trusted or that my omission was willful. And it is notable, while on this topic, that you will not hold Ben accountable for misrepresenting the conclusions of multiple meta-analyses (2 that I’ve mentioned above, plus Shang et al. which I’ve addressed above (also see below) and not recanting his position once its faults are pointed out, nor do you conclude that he is untrustworthy therefore. I wonder at this double standard.

    So now I will have the opportunity to look at the relevant papers in time. Regardless, the many criticisms of the study (see e.g. this compilation of criticisms by the homeopathic community, including one I wrote, some stronger and some weaker but of enough collectively relevance) remain.

    Bass Tyrrell,

    You didn’t touch a nerve, you simply make ridiculous demands that cannot be satisfied.

    You demand “clear proof of an effect”. Please specify the paramaters that would need to be fulfilled for such proof. Otherwise your demand is merely rhetorical.

    Second, I am aware of the dictinction between correlation and causation. What I claimed is that when correlation makes multiple people suspicious of a causation it may be prudent to act cautiously even if there is no “clear proof of an effect” — in such cases I would like to see “clear proof that there is no effect [i.e. side effects of autism etc.]“. I am not well familiar with the literature on this debate (I advise my patients to do their own research and do not counsel them for or against vaccination, as I’ve seen enough opinion on both sides to suggest that the issue is ambiguous).

    BSM

    Perhaps you could perform your public duty and explain to homeopaths like Amazon1954 that homeopathy is just as well-behaved under trial as any other hypothesis.

    I agree that homeopathy should be demostrable with RCTs in principle, yet I don’t agree with you that “homeopathy is just as well-behaved…”: homeopathy is disadvantaged vis-a-vis conventional medications because there are multiple variables required for a good match of remedy and patient, and RCT methodology has to evolve still before it can justly be applied to homeopathy. That there is, despite this, weak evidence of an effect over placebo is quite consistent with your expectation of amenability to RCTs plus my qualification upon it.

    Regarding what I mean by “unambiguous clinical reality”, let me give the following example:

    Do we have an RCT demonstrating the joy-inducing and stimulating effects of coffee on the human organism? Or (just in case there is one) an RCT demonstrating the refreshing properties of orange juice? Yet we agree that it is unambiguous from “clinical” experience that these drinks have the aforementioned effects! Certainly if coffee were discovered yesterday and such claims were being made an RCT would have helped to sort things out, but prolonged clinical experience is a valid substitute.

    The effect of homeopathy is not as obvious as that of coffee so significant clinical experience is required to discern its effects; but nothing says this is in principle impossible, except the outdate positivistic enterprise which concludes from the fact that experience is sometimes wrong to the fact that it is always inqdequate to the task.

    If you were to change your mind about coffee based on convincing RCTs then that would in my mind count as a subversion of humanity (in the term’s abstract sense) by science, which is as much a thing we have to watch for as is the subversion of science by superstitious thinking.

    Finally, to all interested:

    The following is a critical commentary on the Shang et al. study coauthored by K. Linde, the same one who received Ben’s blessing above due to his reconsideration of his own earlier study, and presumably a greater expert on meta-analysis than either Ben or myself
    [PubMed], [Lancet]. The authors are clearly critical of the study’s conclusions as well as of the journal’s complacency. I reproduce most of the comment below:

    … We agree that homoeopathy is highly implausible and that the evidence from placebo-controlled trials is not robust. However, there are major problems with the way Shang and colleagues present and discuss their results, as well as how The Lancet reviewed and interpreted this study. We will point out two.

    First, Shang and colleagues do not follow accepted and published guidelines for reporting meta-analyses. In 1999, The Lancet published the QUORUM statement for improving the quality of reports of meta-analyses3 and the Cochrane Collaboration guidelines are listed in the instructions for authors. Shang and colleagues did not follow either of these guidelines, nor did The Lancet intervene. The QUORUM statement clearly requires that meta-analyses present “descriptive data for each trial” and “data needed to calculate effect sizes and confidence intervals”. Shang and colleagues do not report the trials excluded from the review, the quality assessments and odds ratios of all trials included in the review, nor which eight trials were included in the final meta-analysis. This lack of detail is unacceptable in a paper drawing a strong clinical conclusion.

    Second, problems with pooling are not discussed. Pooling of data from clinical trials makes sense only if all the trials measure the same effect. In our 1997 meta-analysis, we justified the pooling of different interventions, conditions, and outcomes on the basis that, if homoeopathy is always a placebo, all trials measure, in principle, the same thing. There are major limitations associated with this assumption. If homoeopathy (or allopathy) works for some conditions and not for others (a statement for which there is some evidence [Jonas WB, Kaptchuk TJ, Linde K. A critical overview of homeopathy. Ann Intern Med 2003; 138: 393-399. [PubMed]]), then interpretation of funnel plots and meta-regressions based on sample size is severely hampered. Since sample size is not independent of the disease, intervention, and outcome, it is impossible to separate the influence of bias from the true effect size by this method. Therefore, restricting an analysis to the largest studies risks producing a false-negative result. Furthermore, since the main analysis is based on only eight and six (probably unmatched) studies, the outcome could easily be due to chance, as is suggested by the large confidence intervals. Given these limitations, Shang and colleagues’ conclusion that their findings “provide support to the notion that the clinical effects of homoeopathy are placebo effects” is a significant overstatement.

    The Lancet should be embarrassed by the Editorial5 that accompanied the study. The conclusion that physicians should tell their patients that “homoeopathy has no benefit” and that “the time has passed for … further investment in research” is not backed at all by the data. Our 1997 meta-analysis has unfortunately been misused by homoeopaths as evidence that their therapy is proven. We now find it extremely disappointing that a major medical journal misuses a similar study in a totally uncritical and polemical manner. A subversive philosophy serves neither science nor patients.

    Some quotes from correspondence appearing in that week’s journal to which the above is a reply:

    [Peter Fisher et al.:] Shang and colleagues state that “eight trials of homoeopathic remedies in acute infections of the upper respiratory tract … indicated a substantial beneficial effect … [and] sensitivity analyses might suggest that there is robust evidence that the treatment under investigation works. However, the biases that are prevalent in these publications, as shown by our study, might promote the conclusion that the results cannot be trusted”. Here Shang and colleagues suggest that eight studies is too few to question their conclusion about the whole set of publications. Their conclusion about the whole set, however, was also based on eight studies. Is eight enough or not? Shang and colleagues simply refuse to believe the results of positive clinical trials of homoeopathy.

    [Harald Walach et al.:] Second, the six studies of conventional interventions are, by comparison, highly selected. The substances assessed within them have gone through the four clinical pharmacological stages of drug testing. Most newly developed pharmaceuticals do not make it to the last stage of large, multicentre phase IV trials. Therefore the allopathy trials chosen by Shang and colleagues tested medications that had already been largely proven to be efficacious, whereas most homoeopathy trials start from a far less systematic and rigorous evidence base. There have, after all, been very few placebo-controlled randomised trials in homoeopathy, which is why there is an absence of evidence. We are only just beginning to understand how to research homoeopathy and complementary medicine in general. This seems to be an argument for more research, not less.

    An unambiguous reality? I think not.

    In summary, in this thread I have presented evidence that 3 of the 5 meta-analyses with which Ben publicly dismissed homeopathy so not support his claims:

    1) Linde et al. which conclude in favor of homeopathy (even though Linde reinterpreted his results in a later paper, this paper clearly was cautiously positive, and shouldn’t have been cited as evidence without or instead of the later paper).

    2) Kleijnen et al. which conclude weakly in favor of homeopathy.

    3) Shang et al. which is used as evidence against homeopathy but is deeply faulty for reasons discussed or cited above.

    Now, will Ben recant or qualify his public misrepresentation or misinterpretation of the facts? Will anyone on this thread exhort him to do so? I live in hope.

  35. Fralen said,

    November 23, 2007 at 2:26 pm

    The meta-analyses which you claim were positive were only positive when you included all trials, which include various dreadful ones.

    When they restricted the analysis to only the most rigoruous trials, the meta-analyses were negative.

    The figure for the most rigorous trials is the one I am interested in. You choose to quote the figure for all trials, including the poor ones.

    Ben went to great lengths in the Guardian piece to explain why you should pay attention only to the most rigorous trials. I guess you have a reason for rating what everyone would consider to be methodologically poor studies.

  36. wilsontown said,

    November 23, 2007 at 2:40 pm

    David:

    You seem to be well aware of the criticisms of the Shang et al. meta-analysis that were published in the Lancet, so it seems a little odd that you were not aware of the author’s response, published directly after the critical references that you cite.

    For me, I think that some of the criticisms of the reporting in Shang et al. are valid. It should have been clear from the original article which of the studies were deemed to be large and high quality. However, the authors recognise this point and correct it in their response.

    You fail to discuss Shang et al.’s response to Linde and Jonas, who claimed that the possibility that homeopathy may work for some conditions and not others meant a false-negative result was possible. The authors responded: “Their argument
    is not supported by the evidence. The homoeopathy trials analysed in our study, including the large trials, and large trials of higher quality, covered diverse conditions ranging from childhood
    diarrhoea, warts, the common
    cold, to chronic headache. There was little evidence that treatment effects varied according to clinical topic
    (p=0·66). An important strength of our study is the inclusion of a carefully matched sample of conventional medicine trials. If the fact that a therapeutic
    system may work in some but not
    other conditions leads to false-negative results, why did this not happen in the case of conventional medicine?”

  37. wilsontown said,

    November 23, 2007 at 2:41 pm

    My apologies for totally buggering the formatting on that last post…

  38. David / Homeopathy Zone said,

    November 23, 2007 at 3:01 pm

    Fralen,

    I suggest that you refer to the original trials rather than to Ben’s interpretation rather than the original, because at present you are defending Ben’s position by quoting Ben, which is tautological:

    1) From Linde et al.: “… However, an analysis restricted to only the very best subset of these trials reduced, but again did not eliminate, the effect found (odds ratio [in favor of homeopathy] of high-quality trials, 1.66)” [The 95% interval was 1.33-2.08]. The “worst-case scenario” that they explored yielded an odds ratio of 1.97 [1.04-3.75] – weak, arguably unconvincing evidence for, but absolutely no evidence against, homeopathy!

    If Ben had a problem with this study based on Linde’s later reinterpretation then the latter study should have been quoted… but why bother when your audience will go along anyway?

    2) From Kleijnen et al.: Even though “at the moment the evidence is positive but not sufficient to draw definitive conclusions”, they commented that “[t]he results showed a positive trend regardless of the quality of the trial or the type of homoeopathy used.” If Ben disagreed with this point and then this is a legitimate point of debate, but until he does so he shouldn’t have distorted the trials stated conclusions.

    3) The Shang et al. study is flawed in essence, i.e. precisely in its method of arriving at the purportedly highest-quality trials, and in any case (even if we leave its flaws aside) shows wide confidence intervals of the sort that would immediately be claimed inconclusive if the result were in favor of homeopathy.

  39. David / Homeopathy Zone said,

    November 23, 2007 at 3:22 pm

    wilsontown,

    I only became familiar with the above-quoted criticisms today thanks to Fralen’s referral.

    This is because my involvement with the study was limited to the few weeks following its publications (and so did, incidentally, that of many decision-makers around the world who were irresponsibly exhorted by the Lancet editorial to make clinical recommendations accordingly!), when such and other criticisms were brought up in various forums already long before they made it on paper in the above replies. Hence I was mostly familiar with their content from before even though not with these letters specifically.

    I didn’t find Shang et al. reply at all convincing or worthy of quote; specifically their statment:

    An important strength of our study is the inclusion of a carefully matched sample of conventional medicine trials. If the fact that a therapeutic
    system may work in some but not
    other conditions leads to false-negative results, why did this not happen in the case of conventional medicine

    is quite opaque. First, what’s a “carefully matched sample of conventional medicine trials” when they were criticized as not having followed proper meta-analysis standards in the first place? Do you really believe that choosing 6 trials out of many many thousands has a high probability of extracting a representative sample? If homeopathy studies, of which there are few, need to be cateogrized to different types, then even more so trials of “conventional medicine” – an incredibly, almost indeterminably heterogeneous entity. To me and many other critics, theirs is a basically absurd comparison.

  40. wilsontown said,

    November 23, 2007 at 3:48 pm

    David, as I read the criticism by Linde and Jonas, they weren’t criticising the way the meta-analysis was conducted, but the way it was reported. This is an important difference. As I say, I think that there is some validity to these criticisms, but they don’t necessarily undermine the research itself.

    I think the key point with Shang et al.’s reply is that they showed there was no evidence for any difference in treatment effects between different clinical topics. This effectively answers the Linde and Jonas criticism regarding potential false-negative results.

    As for “Do you really believe that choosing 6 trials out of many many thousands has a high probability of extracting a representative sample?”, well no I don’t believe that. But that was not the objective of the meta-analysis. The original Shang et al. paper was testing a specific proposition, that the effects of homeopathic remedies are placebo effects. If that were the case, then positive results in trials of homeopathy must be explained by biases in the trials. They test this by looking for the best-conducted trials and comparing to the trials of lesser quality. So the trials aren’t supposed to be a representative sample. They’re supposed to be the best conducted trials.

  41. Harlequin said,

    November 23, 2007 at 3:54 pm

    Fralen: “When they restricted the analysis to only the most rigoruous trials, the meta-analyses were negative.”

    Egger’s 2005 review got a positive result even from the 20 “higher quality” trials (not identified anywhere that I can find), comparable with the 9 “higher quality” biomedical trials (from 110 trials “carefully matched” for everything except quality? Duh…). Only after further restricting the group to “larger, higher quality” trials did Egger obtain the “death of homeopathy” result that the homeopaths say he was after all along. I do a sensitivity analysis, you do some data dredging, the homeopathic morons cherry-pick, of course …

  42. Bass Tyrrell said,

    November 23, 2007 at 4:03 pm

    David / Homeopathy Zone: “homeopathy is disadvantaged vis-a-vis conventional medications because there are multiple variables required for a good match of remedy and patient, and RCT methodology has to evolve still before it can justly be applied to homeopathy.” What a complete load of cobblers. It is an absolute staple of experimental design that you test single variables, keeping all else equal. In the case of homoeopathy you could design a study for a specific remedy in which only patients for which you had matched the patient to the specific remedy already were included: those patients are then randomly allocated to the test and control groups (and of course the trial is double blinded). Every single variable apart from whether the sugar pill has had a drop of whichever remedy it is put on it. Measurable outcomes are defined – these could be subjective (does the patient report feeling better) or more preferably objective. It is not rocket science! What is the problem with it?

    Incidentally this also answers your question as to what I would regard as clear evidence of an effect.

    On correlation vs causation this time you say “What I claimed is that when correlation makes multiple people suspicious of a causation it may be prudent to act cautiously even if there is no “clear proof of an effect” —”. This is quite different from your earlier assertion that controlled studies should not “trump” clinical reports. There are mechanisms in place to report observed correlations that could be down to the side-effects of medical intervention, including vaccination, and this is exactly as it should be. This in turn leads to the controlled studies that (assuming they are properly constructed) now cover a random selection of the population (in this case vaccinated/unvaccinated, autistic / not autistic) and conclude whether there is statistically significant evidence of causation. OF COURSE these studies trump individual reports, because the individual report in itself says nothing about cause.

  43. David / Homeopathy Zone said,

    November 23, 2007 at 5:23 pm

    wilsontown,

    Linde and Jonas criticized presentation in their first objection, but methodology in their second.

    Please also refer to other criticisms that I linked to in my long post above.

    If you read the study you will see that there are so many assumptions that it is impossible to use the conclusion one way or the other, and performing the study slightly differently could easily yield different results (as they themselves report: the positive results when an intermediate subsample was used, and positive results in the subsample of respiratory conditions whose “substantially beneficial effect (odds ration 0.36 [95% CI 0.26-0.50])” they sicount since “the biases that are prevalent in these publications, as shown by our study, might promote teh conclusions that the results cannot be trusted” — in other words, they clearly state that the purpose of their paper is to show that bias is a valid alternative explanation to the efficacy of homeopathy, whereas they don’t claim that it in fact is — see more right below).

    For me the most problematic thing about the Shang et al. trial is in the text itself:

    We assumed that the effects in placebo-controlled trials of homoepathy could be explained by a combination of methodological deficiencies and biased reporting. Conversely, we postulated that the same biases could not explain the effects observed in comparable placebo-controlled trials of conventional medicine.

    This is a clear statement to the effect that they used the starting 110+110 sample and from there reverse-engineered the results to match their hypothesis: While the 110 trials on each side were selected based on pre-existing criteria, nowhere is it reported that the quality criteria used to narrow down the selection were pre-selected and not chosen during the process, and their wording suggests that the latter might have been the case. This is legitimate but completely different from a meta-analysis on whether the homeopathic effect is real or not!

    In other words, their study was designed to test the hypothesis, and can be used only to conclude, that one possible explanation for the positive results of homeopathy trials is that they are beset by their proposed set of biases — nothing more! This is the most generous reading of the study that I can discern, and the only legitimate one. Using it for any further claims is completely unjustified, and I don’t understand why the skeptical community will not simply let this study be, but insist on waving it as a tattered victory flag.

    Bass Tyrrell,

    It is extremely difficult to gather a sufficient number of patients requiring the same remedy except in situations of epidemics: for chronic conditions, with at least many hundreds of remedies in use, one would need thousands of subjects to gather at best several tens of subjects requiring a popularly used remedy (which may or may not be a sufficient number for your desired level of conclusiveness), and their clinical conditions would be quite varied that different subgroups might each require a different followup regimen and study design. Recruiting patients is often a challenge even for the most well-funded multicenter trials, so I am not sure this is practicable, except as mentioned in epidemics, or perhaps in acute situations in cooperation with a hospital emergency department (since acute prescriptions, unlike chronic ones, are fairly highly correlated with the medical diagnosis). This is what I meant by that homeopathy is disadvantaged in study degisn.

    A viable alternative is to use simplified homeopathy where one remedy is given per condition based on its frequently being indicated for that condition (this is contrary to classical homeopathic principles but might still yield weak results, and occasionally does in studies).

    An very elegant work-around is to use an automatic way of matching remedy to patient, for example by preparing a custom mixture of pollen based on the specific allergic sensitivities of each patient as determined through conventional means, so that the remedy is at once individualized to a degree (this approach is called “isopathy” and represents a simplified variant, again, but one that tends to be effective at least in the short term). So the remedy is different for each patient but is in every case diluted identically (I don’t see this as a problem as science’s view of say a 30c dilution is the same irrespective of its specific ‘contents’).

    Well, this last approach is what was done by Reilly et al. in the study I quoted earlier above. I invite you to read it thoroughly. It is a clearly presented study that should be amenable to criticism, which I welcome hereby. Does this study suffice as clear evidence? If you answer in the negative I’d like to know why, so as to determine what further criteria you’d require for clear proof.

    Otherwise, do you insist on the first design despite the practical problems associated with it? If so, and supposing that that type of study were performed, would you consider its result evidence for homeopathy in general or just for the single remedy tested? (You should recognize that if you answer the latter then effectively you’d be asking for many hundreds of RCTs, each of the aforementioned degree of complexity, to “prove that homeopathy works”.)? If for the single remedy tested, then for its effect in all diagnoses encountered during the study even if evidence for any single diagnosis might involve only a single patient (the change of a specific crossing of remedy and diagnosis is very low)?

  44. BSM said,

    November 23, 2007 at 11:54 pm

    Sorry David, but now you are saying even more idiotic things;

    “If you were to change your mind about coffee based on convincing RCTs then that would in my mind count as a subversion of humanity (in the term’s abstract sense) by science, which is as much a thing we have to watch for as is the subversion of science by superstitious thinking.”

    I assume you are unaware of the well recognised experimental model in which people are given drinks that they are told are alcoholic, but which are not. Their performance is affected just at it should be had the alcohol really been present.

    e.g. news.bbc.co.uk/1/hi/sci/tech/3035442.stm

    May be you also do not know that behaviours elicited by false correlation in animal psychology experiments are dubbed ‘superstitious responses’ because that term so neatly encapsulates the fallacious causal linking that you also exhibit.

    I’m sorry, but the simplistic universe you wish to inhabit just does not exist. This is why homeopaths inhabit such tiny boxes.

  45. Bass Tyrrell said,

    November 24, 2007 at 10:37 am

    David / Homeopathy Zone: yes, you would have to prove efficacy of all treatments, why should homoeopathy be different? If, as you claim, the remedies you use are distinguishable then their effects on the human body must differ and hence you couldn’t claim one works just because another one did!

    I am glad you are no longer claiming that homoeopathy is in principle different, merely that the logistics of a trial would be difficult. Well, so are the logistics of many trials but they have to be done. I was under the impression in any case that while there may be many hundreds of remedies a few common ones would be far more used than others? If this is the case you could start with those.

    Of course, using all remedies simultaneously in the trial and getting significant positive results would indicate something surprising going on (and have scientists scurrying after Nobel prizes right after they’d finished eating their hats), but negative results would be easier for you to try and explain away!

    You do realise don’t you that what you regard at weak results at best for the homoeopathic community indicate that, even if there were an actual effect, that you are not very good at harnessing it!? It is of course more probable that a weak result is to do with statistical anomaly, confounding variables not being eliminated or conscious or unconscious bias.

    Anyway, I will take a look at the Reilly et al study and come back next week.

  46. Chris_Ch said,

    November 24, 2007 at 7:30 pm

    John F Kennedy once said this

    ‘The great enemy of the truth is very often not the lie — deliberate, contrived and dishonest, but the myth, persistent, persuasive, and unrealistic. Belief in myths allows the comfort of opinion without the discomfort of thought’

    A relevant quote think, particularly the last sentance

  47. David / Homeopathy Zone said,

    November 25, 2007 at 1:35 pm

    BSM,

    You are precisely supporting my point: even though you recognize that the effects of alcohol, coffee, etc. could be replicated by placebo, you do not base your belief in the reality of their physiological influence on RCTs — otherwise you would have to be demanding an RCT proving that there is a physiological influence in order to retain your belief! Rather, I suggest You believe in the effects of coffee and alcohol from personal experience, hearsay, cultural history, etc., and that it is rational to do so. Accordingly, I was suggesting that you would be hard to sway by an RCT that went contrary to your belief (say one that failed to show difference from placebo when people are told that the drink is inert yet the verum contains the active substance in question).

    This is the same with homeopathy, except that homeopathy doesn’t form part of our shared cultural history, and you have zero trust of homeopaths, idiots that they are… so our cultural history and experience are irrelevant to you. This is totally justified, and I don’t expect you to believe in homeopathy without having your own experience of it (in fact, I would consider you gullible and uncritical if you did). My only concern is when people speak against homeopathy out of ignorance, as though they know the truth of the matter on cursary inspection, instead of keeping silent and agnostic. You behave like a person who arrives somewhere new where he is given alcohol for the first time in his life, and he refuses to try it, refuses to believe when he sees others affected by it, and wants to see an RCT showing its effect, all the while publicly proclaiming his disbelief.

    Bass Tyrrell,

    My point is that your demand is unreasonable, as it requires the sort of research enterprise that only patentable pharmaceuticals can muster; it ignores the reality that knowledge is gained through money and that there has been a trend toward a situation where only those with money can satisfy the extremely stringent demands that they themselves have had a hand in establishing (this is not conspiracy theory, just the natural economic and political dynamics of the system). Moreover, you are asking homeopathy to go down a path which, to date, has not produced any evidence of its superiority over rational, careful clinical medicine, and which arguably is partly responsible for the unsustainable rise in health-care costs over the past 2 decades.

    But as I’ve been arguing this is not the only approach to establishing evidence. Given that we are in agreement that homeopathic substances are not dangerous, they do not necessarily be as rigosourly tested (please read up on the history of RCTs, as this point is of huge importance in the rise of RCTs). Also, if remedy A is proven to work, and remedy B, and remedy C, then presumably remedy D has a higher chance than before of also proving to work, because the law of similars (of which there is no parallel in conventional medicine) provides a common basis for the remedy’s operation.

    Your suggestion that each remedy has a distnict effect in the body is incorrect: a remedy is a stimulus and its effect vary greatly from person to person: one person on remedy A will have a headache improve, another will have a skin problem flare up and then resolve, a third one will gradually cease to be depressed, etc.

    The weak results of homeopathy in trials are due to limitations of study design and the fact that deep improvement often takes longer than the timeline of most studies. The reality of clinical work is that sometime more than one remedy is required to produce improvement, sometimes there is a periodic worsening of symptoms before their resolution, etc., and the timeline is difficult to predict as it varies based on many factors and not just the presenting complaint. (FYI, I just published an article on my blog about forecasting length of homeopathic treatment in chronic conditions, which should give you a sense of the complex clinical reality of the homeopathic treatment process.) Presumably long-term, well designed studies where prescribing can be completely individualized with no limitations would produce results that have more external validity vis-a-vis real-life practice; but such study design often comes at a cost to internal validity (this is simply a fundamental feature of controlled studies, nothing to do with homeopathy), which then exposes the study to criticisms about robustness of method.

    I have no objection to such studies but know that they wouldn’t make a difference to people’s opinions, because there are many aspects of homeopathy that don’t fit into the current scientific world-view, much more than the issue of dilutions.

    Instead, I strongly support observational studies in a health-care paradigm that allows patients full choice of treatment. In such a framework costs could be optimized by allowing people to choose low-cost solutions regardless of whether they were scientifically proven or not, so long as they were not dangerous (comparative observational studies could measure such dangers), and if this were done with medical supervision and cooperation then errors of omission would be minimized. This would allow for a health-care system where the placebo effect is harnessed without degrading the status of science in society.

    Instead, at present we are seeing the conventional medical system fraying because of its own over-ambitious paradigm, and it will collapse anyway back into a private system where cost and clinical efficacy per se will determine choice of treatment.

  48. Ben Goldacre said,

    November 25, 2007 at 1:39 pm

    does someone want to calculate how much money homeopaths have wasted on methodologically inadequate trials that produced spurious false positive results?

    lots of people do duff trials, but it would be interesting to know how much money has been unnecessarily thrown down the drain, given the frequency with which this claim about big pharma holding all the cards comes up.

  49. BSM said,

    November 25, 2007 at 9:44 pm

    David

    I really don’t think you understood the point about the alcohol experiment did you.

    Personal anecdotal experience is a rough rule of thumb and a handy guide in the absence of better information, BUT IT IS OFTEN WRONG.

    “Accordingly, I was suggesting that you would be hard to sway by an RCT that went contrary to your belief”

    No I would not. If someone demonstrated that caffeine of itself has no appreciable stimulatory effect when taken in the routine doses present in the coffee I drink I’d have to accept that my personal experience was mistaken. That’s the grown-up thing to do instead of acting like a petulant child insisting you are right and the world is wrong.

    Nonetheless with that particular example, you know and I know that a double blind trial of caffeine would show a physiological effect and personal experience happens to be in agreement, but that does not mean that personal anecdote is a substitute for controlled trials especially when the effects being looked for are vague and subtle. Quite the reverse.

    I’m afraid all you homeopaths who drone like zombies, “Take a pill, feel the effect, take a pill, feel the effect” just ignore us when you are told that some of us have taken one of your magic pills and felt no effect whatsoever. Maybe you are more gullible, maybe you so want to believe that there is something going on that you will report an amazing effect when you take a lactose tablet even though it cannot have a real physiological effects, but you are behaving in a manner exactly like those experimental subjects who were given fake ethanol. That was such a simple example I am disappointed that you didn’t understand it.

    I’m afraid you will obstinately continue to present your own superstition and gullibility as a virtue.

    I’ve said this more than once, but it is a sad waste of your life to believe in this nonsense. Face it, you only get one go at this life and it is a pity to spend it believing a lie. Even if you are a Buddhist, it’s hardly gaining good karma to be deliberately stupid!

  50. David / Homeopathy Zone said,

    November 25, 2007 at 11:47 pm

    A correction of the last sentence of par. 4 above: “…because you are making a judgement from observation (your experience) which you forbid me to make based on my observational experience.”

  51. BSM said,

    November 26, 2007 at 8:19 am

    “I still think you are acting inconsistently by not demanding an RCT of coffee or alcohol to be performed, because you are making a judgement from observation (your experience) which you forbid me to make based on my observational experience.”

    Strictly speaking, I forbid anyone to make such judgements, myself included.

    What you demand is the right to make judgements without oversight by RCT when, as I have clearly demonstrated, such judgements are woefully inaccurate.

    My problem with you is that you then translate that obstinate error into a demand to be left alone to make a living from that error.

    “It is based on this reading of the science that I base my conviction about homeopathy, apart from the fact of helping people with conditions considered incurable…”

    Oh, yes the claim to help the “incurable”. Since you bring this matter up;

    GIVE ONE, YOU ONLY NEED ONE, INCONTROVERTIBLE EXAMPLE, WITH REFERENCES, OF HOMEOPATHY CURING A NON-SELF-LIMITING CONDITION.

    Do that and I’ll grant you have a legitimate right to take people’s money for your sugar. You have an entire 200 years of history and I’ll take evidence from any species or any country so you needn’t bother with the excuse that poor downtrodden homeopaths aren’t allowed near seriously ill people in your jurisdiction.

  52. BSM said,

    November 26, 2007 at 11:31 am

    “And are these not distinct and measurable effects?”

    And the homeopaths are keen to tell us how they ‘cure’ people, so they are certainly applying some sort of criterion to define when their remedies have succeeded.

    Basically, when they want to sell people sugar they’re full of confidence in the reliability and reproducibility of what they do. When less friendly eyes want to scrutinise them, all this certainty disappears out the window.

  53. David / Homeopathy Zone said,

    November 26, 2007 at 2:49 pm

    Bass Tyrrell,

    My point about hom. remedies not having distinct effects is that it acts as a “catalyst” on the “reactions” the organism undergoes rather than as a “reagent”. This is also the reason why its effects mimic natural healing patterns. Sometimes catalysts accelerate reactions that would have happened anyway, as in your toothache example (so it’s difficult or impossible to determine from clinical observation whether this is the case), but sometimes that cause reaction to happen that would never happen otherwise (as in non-self-limiting chronic degenerative conditions).

    In order to research hom. adequately one would have to account for complex situations such as a patient reporting the worsening of his 5 leading physical complaints concurrent with an improvement in sleep during the first weeks of treatment. Such a pattern is a favorable outcome that is an excellent predictor or an eventual improvement of those symtpoms. It is this long-term perspective that has to be factored into long-term studies with a sophisticated design that takes into account that an aggravation is sometimes a good sign and not a side-effect or a worsening of the condition — but this is determined in consideration of other symptoms, as symptoms are not independent variables. I am not aware of any such designs at this point. One PCRCT design I can see working is one where no limitations on clinical method are imposed and a sufficient time is given to obtain results (say 2 years in chronic complaints), with gradated (non-binary) outcome measures that include subjective quality-of-life questionnaires alongside objective measures).

    Here is an interesting article on the topic of the complex nature of the clinical response to homeopathy. It may seem like rubbish until one witnesses these effects in the clinic on a startlingly regular basis.

    BSM,

    “GIVE ONE, YOU ONLY NEED ONE, INCONTROVERTIBLE EXAMPLE, WITH REFERENCES, OF HOMEOPATHY CURING A NON-SELF-LIMITING CONDITION.”

    I am unclear as to whether you are asking for anecdotal evidence or studies, and what are or aren’t self-limiting conditions in your definition, given that virtually any condition can theoretically show so-called “sponteneous remission”.

    If you are asking for studies and for general evidence that hom. might be possible, I don’t see why you should reject studies of non self-limiting conditions that produce statistically significant results (even if they can be claimed to be clinically negligible), such as some of the Oscilococcinum studies (non-individualized hom. treatment for flu). I mentioned above the challenges of doing studies of chronic conditions and most existing studies are of acute conditions (though hopefully in time longer-term invfestigation will be made), but statistical methods ensure that even self-limiting conditions can be investigated reliably.

    If you are asking for anecdotal evidence then I don’t know where to begin, as there are so many. You can look up homeopathic journals, but then whatever is in them can be dismissed as rubbish. I could tell you concrete clinical cases; but you would dismiss them in one way or another. So my question is what sort of authority, evidence, and references you’d require, and what are some medical conditions you’d include in the list?

    The criteria that homeopaths apply to judge improvement are described in the link to the article above. Basically an overall change for the better is looked for (energy level, sleep, mood, sense of control of one’s life, etc.) alongide an improvement in medical complaints, where the most important is the subjective discomfort (e.g. pain disappearing), followed by objective measures such as x-rays or blood tests. There is no single, clearcut criterion for every disease because the patient’s sense of well-being is the primary criterion (recognizing that this sense is sometimes deceiving); this contrasts with situations in conventional medical practice where all objective criteria of health are satisfied yet the patient is clearly in suffering. Neither of these two approaches is fault-proof.

  54. BSM said,

    November 26, 2007 at 3:21 pm

    David

    I am not for now interested in the controlled studies. None support your case, indeed it is a big fat lie that they do for Oscillococcinum, but you may not have read the studies themselves so I’ll grant that it may instead be a big fat couldn’t be bothered to look at the primary literature but I believe what I read on homeopathic websites.

    “If you are asking for anecdotal evidence then I don’t know where to begin, as there are so many. ”

    Actually there aren’t and I’d like you to produce one, please.

    You see, we get this claim time and again from homeopaths. You have just made the claim yourself

    ” but sometimes that cause reaction to happen that would never happen otherwise (as in non-self-limiting chronic degenerative conditions).”

    but even on a case-anecdotal basis this seems to be, now how can I put this delicately, an enormous flat-out lie.

    It would probably be best to report something from your own cases because you can then be confident that it is well documented and will stand up to scrutiny.

    And before you go off on a tangent about sceptics not wanting to believe anecdotes all I’m trying to demonstrate to you is that regardless of its failure in controlled trials, even the anecdotal record of homeopathy is based on falsehoods.

    So, a nice clear-cut cure of cancer, please. Or an AIDS patient cured. End-stage renal failure. Cirrhosis of the liver. Something impressive.

    Off you go now and have a think…

    GIVE ONE, YOU ONLY NEED ONE, INCONTROVERTIBLE EXAMPLE, WITH REFERENCES, OF HOMEOPATHY CURING A NON-SELF-LIMITING CONDITION.

  55. David / Homeopathy Zone said,

    November 26, 2007 at 4:35 pm

    BSM,

    Your contempt for everything homeopathic precludes you from impartially investigating the issue.

    You must be aware that there are case reports in the medical literature of all sorts of non-self-limiting conditions showing spontaneous recovery or placebo response. So any evidence I will give you will not in itself prove anything. More broadly, nothing that I will say will obviate the need for you to enter a busy clinical setting and observe for a sufficient length or time, in order to make an informed judgement.

    A couple of impressive reversals of degenerative conditions that I have been privy to:
    1) Full recovery from serious (functionally fused spine with extensive calcification) ankylosing spondilitis over a 5 year period, in an ongoing teaching clinic where I have had the opportunity of observing for the past 2 years. X-rays were of course performed, and slight abnormalities remain on x-ray (these may improve over time as the case is still being followed up), but flexibility is within normal range and the patient is pain-free.
    2) Recovery from MS (ascending lower body paralysis threatening the diaphragm) over a 6 year period to the point of being able to walk for 1 hour a day (not a full cure? good enough for me!). This is a case recorded on video, and the patient can be seen to be older over time so it wasn’t filmed in reverse (but then it could have all been acted up!).

    I don’t have such impressive cases myself as I have only been in practice for 3-4 years and am only lately beginning to take on really complex cases. An example I consider impressive is in someone I have known for over 20 years, a young woman with developmental difficulties (learning disabilities, depression, aversion to washing for weeks at a time, sensitive to insult to which she would react in rage) and for the past 5 years before treatment, eczema on her face and chest. Over a 1.5 year period of treatment her eczema disappeared (self-limiting), her mood transformed for the better, aversion to washing disappeared, sensitivity to insult gone, and — this is the deepest sign of cure — she is fast transforming from looking boyish to maturing into a woman. In time her learning difficulties may improve, and she is not fully healthy, but this is more than enough of a ‘cure’/ The complex of these symptoms is, in principle, something that could occur through normal development, but as someone who was stuck in the same developmental status from birth (there was birth trauma) or at least from ages 5 (when I first saw her) to 25 and suddenly in 2 years made such a leap, this is impressive clinical evidence.

    Again, this is unconvincing until you see it yourself. Absent your willingness to do so, you have no basis on which to claim that these results are irrelevant as evidence, and conversely I am not presenting this as evidence for homeopathy but as an illustration of the sort of evidence that I base my judgements on.

    I don’t think we can progress beyond here unless you are willing to consider the validity of clinical observation. I am well aware of the limitations of such observations vis-a-vis the positivistic enterprise of EBM, but clinical outcomes speak to the validity of such an approach, and these can be reserached with comparative observational studies, which I believe are the wave of the future in a sustainable health-care system. Again, I am willing to take the logical possibility that all I am doing is placebo if I get great clinical results, and conversely I find no solace in the abstract beauty of the ideal of the RCT as the gold standard unless it can help me to achieve such results. I will repeat that Communism also used rationalistic principles to justify itself, but in real life it proved limiting and ultimately destructive (even though certain of its ideas are very much applicable in a healthy democracy).

  56. Bass Tyrrell said,

    November 26, 2007 at 5:46 pm

    BSM: “being dead is a sub-optimal outcome ” – since the patient then presumably would not fill out their “subjective quality-of-life questionnaire” they could simply be regarded as non-cooperative.

  57. BSM said,

    November 26, 2007 at 7:42 pm

    So, David, I’ll take that as a ‘no’.

    Doi you really mean to tell me that out of the entire 200-year history of homeopathy there is nothing better that you can find. And these cases aren’t ‘cured’ by even your relaxed standards.

    Come on, man. You’ve been taught by homeopaths. You’ve read the books. Homeopathy is a ‘complete system of medicine’ able to cure the incurable cases.

    Please try harder.

    Also, can we please just drop this stupid assertion;

    “I don’t think we can progress beyond here unless you are willing to consider the validity of clinical observation”

    I may only be a veterinarian, but that still makes me more of a clinician than you are. I am well aware of what it means to make clinical observations. We have already demonstrated that clinical observation cannot trump controlled data and is wrong in a frustratingly high proportion of instances especially when the symptoms are highly subjective. I have no problem with accepting that clinical observation often leads to false inferences. You have a weird little straitjacket applied to the way you approach your cases if you take your own observations at face value.

    Why do you persist in this false belief?

    “and these can be reserached with comparative observational studies”

    Define ‘comparative observational studies’.

    The relevant studies are homeopathy with ‘real’ remedies and homeopathy with ‘blanks’. This has been done, David. Time and again it has been done. Homeopathy’s little pills do not work. Why can you not accept this and earn an honest living as a counsellor instead of the dishonest and deceitful path you are embarked upon? It really is quite tragic that you would choose to throw away your life on this stuff.

    “find no solace in the abstract beauty of the ideal of the RCT as the gold standard unless it can help me to achieve such results”

    But is has done exactly what one requires of it. It has shown you to forget homeopathy’s little pills. You just don’t want to be told that.

    The reference to Communism is just weird and irrelevant.

  58. BSM said,

    November 26, 2007 at 8:06 pm

    I ought to say specifically with respect to;

    ” birth (there was birth trauma) or at least from ages 5 (when I first saw her) to 25 and suddenly in 2 years made such a leap, this is impressive clinical evidence.”

    It really, really isn’t. I am just dumbfounded that you would even bother to bring forward a case like that.

    p.s. With your ankylosing spondylitis, I take it that no other treatment has been given and that no physiotherapy has been undertaken or else why would you present it here. Please confirm that homeopathy alone was used. By the way, I have a staff member with ankylosing spondylitis. That has remitted as well (for now). Ain’t nature wonderful if left to get on with things…oops, you wanted that to be a sugar-pill effect, sorry.

    Homeopathy = Too easily impressed.

  59. Bass Tyrrell said,

    November 26, 2007 at 9:20 pm

    David / Homoeopathy Zone: writes “My point about hom. remedies not having distinct effects is that it acts as a “catalyst” on the “reactions” the organism undergoes rather than as a “reagent”. This is also the reason why its effects mimic natural healing patterns. Sometimes catalysts accelerate reactions that would have happened anyway, as in your toothache example (so it’s difficult or impossible to determine from clinical observation whether this is the case), but sometimes that cause reaction to happen that would never happen otherwise (as in non-self-limiting chronic degenerative conditions).” This is pure unadulterated nonsense of a high degree. Exactly what you are trying to say with your distinction between a catalyst and a reagent is far from clear but irrelevant in any case: if you administer a substance and it has an effect it is possible to measure the effect! As for “cause reaction to happen that would never happen otherwise” this would hardly be natural healing now, would it?

    You are full of excuses as to why you cannot possibly isolate single variables to test them. But if you ever want homoeopathy to be taken seriously you need to find a way of doing so – nothing, but nothing, that has been said here has made any sort of a case as to why this is impossible or even impractical. Your latest effort focused on cost. But there James Randi’s one million US out there, or if that is too risky because it wouldn’t be paid until after proof came along surely homoeopathy has some rich clients who would gladly fund the necessary research (the author Jeanette Winterson maybe)? And even if none of those come up trumps, you could always enlist the help of Big Pharma! Because you know what, if you could provide even relatively weak evidence to Pfizer, GSK, Bayer or similar company they would jump at the chance to make effective medication with such a low manufacturing cost. They would even help design the study (as will the JREF people too).

    By the way, the toothache example was, deliberately, ridiculous (even though it is a true story). That you even entertain the notion that the remedy could be claimed to have some effect in that case shows how far you are from reality.

  60. David / Homeopathy Zone said,

    November 26, 2007 at 9:29 pm

    BSM,

    The AS case was severe enough that you would be suprised if it remitted; certainly his doctors were. Not proof, just compelling evidence (for gullible me).

    Re my case: You to fail to see that such cases are precisely the sort of thing that constitutes true healing as opposed to symptom removal. I cannot convey it in words, but her whole being transoformed in less than two years in a way that it hadn’t in all her life up until then (I brought up this case precisely because it’s one where I’d had first-hand evidence of her past state). You cannot dismiss such a change in her developmental trajectory (she was 25 at the beginning of treatment so it wasn’t puberty related but a highly atypical global shift in an adult) as unimpressive, nor can you reproduce it with conventional medications except possibly when growth hormone is indicated.

    It is notable that conventional medicines that she had received on and off through her life did not bring her to this state at any time, nor did various psychological treatments. But I cannot explain what healing means to one who is intersted in numbers and pathologies alone, I am sorry.

    If you are genuinely interested in well-recorded cases histories of severe pathologies and cancer I can recommend contacting Andre Saine, a senior homeopath from Montreal, here, who might be willing to provide such material, as he’s made it his speciality to treat precisely the sort of complex cases that you suggest might impress you.

  61. BSM said,

    November 27, 2007 at 9:36 am

    No, David, I am asking you to provide the evidence.

    By trying to pass the buck you are conceding my point.

    These dramatic cures always seem to happen with someone else never to the particular homeopath that one is asking. I can accept that you are inexperienced, but you are supposed to be familiar with your own literature, so find a case that has been properly documented.

    Try again,

    GIVE ONE, YOU ONLY NEED ONE, INCONTROVERTIBLE EXAMPLE, WITH REFERENCES, OF HOMEOPATHY CURING A NON-SELF-LIMITING CONDITION.

    With respect your spondylitis case and your developmental neurology woman, I shall simply repeat that you are far too easily impressed, and I shall also repeat my request that you confirm that neither patient received any other intervention either medical, physical or psychological while they were under homeopathic treatment. Now that is something you have direct access to, so please be so good as to answer clearly and succinctly.

  62. BSM said,

    November 27, 2007 at 9:47 am

    Hang on a sec’ you said that the spondylitis patient had X-rays, so they are under conventional medical care.

    Are you claiming that conventional medicine was used to monitor the patient but absolutely no other conventional interventions were made? That would seem inherently unlikely. Please confirm exactly what was going on.

  63. David / Homeopathy Zone said,

    November 27, 2007 at 8:44 pm

    BSM,

    The AS patient was definitely on medications concurrently, anti-inflammatories and painkillers as needed. But they were gradually weaned over the treatment period and eventually discontinued during the 5th year of treatment.

  64. David / Homeopathy Zone said,

    November 27, 2007 at 10:02 pm

    … With regard to journal cases: I requested specific criteria before I could supply you evidence, as I am not interested in playing a game where I am bringing evidence and you get to specify criteria after-the-fact.

    Besides, the best evidence I can provide you is my own or that which I have observed as a third-party or that by those whom I personally trust. These is more reliable evidence in my mind than journal cases that don’t undergo formal peer-review of the sort you would approve of and are often poorly written up.

    Your request for cures of what is end-stage, probably irreversible pathology are not reasonable, though I did refer you to someone who is a widely recongized expert on precisely this sort of evidence. I still require a definition or list of pathologies that are not self-limiting yet curable in priniple. MS? (Yes it is subject to remissions in many instances but mostly symptomatically rather than pathologically, and hardly in the severe case that I described above, which you didn’t address) Advanced ankylosing spondylitis? You are unimpressed. Lifelong developmental delays? You are unimpressed.

    So please specify your criteria. You still didn’t address my comment that even extreme conditions have been recorded to have reversed for unkown reasons so I don’t see how any example I would give is not dismissible as either placebo or spontaneous remission. What is “incontrovertible” when you fundamentally mistrust the reporter’s credibility and I cannot supply you the patient in “before” and “after” stages for your personal inspection? What references do you want when we are discussing case reports rather than academic articles? Finally, I don’t see the importance of excluding adjunct care when that care is not known or intended to cure the condition, as in the AS case.

  65. BSM said,

    November 27, 2007 at 11:01 pm

    David,

    You don’t need to know about end-stage pathology! You only need to know about symptoms so stop trying to cheat. Conventional medicine is allowed to peek at the back of the book to find the answers, all you have are symptoms. The fact that the real doctors may have made a proper diagnosis and that diagnosis may be know to you does not affect the claims made for homeopathy nor does it affect your therapeutic approach- take a history, repertorise, prescribe remedy, re-take history.

    In my terms the patient could have chronic myeloid leukaemia or could have Chronic Fatigue Syndrome. I know how to differentiate the two. You are a homeopath. The symptoms are king. It doesn’t matter to you what the patient’s conventionally diagnosed dis-ease is (in the nauseatingly twee homeopathic jargon).

    Please try to be consistent to your ‘paradigm’ or I might have to conclude that you keep homeopathy tucked away from the real challenges of serious disease and safely in a corral with all the problems suffered by middle class people with too much time and too much money where you can apply your placebo to maximum effect. I want you to tell me about real cures of real structural physical disease. The fact that your spondylitis patient wasted their money with you while conventional medicine controlled their signs does not provide evidence for homeopathy. It does provide evidence for the homeopath’s tendency to circle vulture-like on the periphery while real medicine does its job and/or nature takes its course.

    So, I see no reason not to present you with a requirement to come up with a homeopathic cure for something like cirrhosis of the liver. After all, in Hahnemann’s day that would have been a patient suffering dropsy, lethargy and fatty pallid stools.

    Or how about AIDS. Homeopathy has no place for the germ-theory of infection, so it makes no difference to you whether we can measure HIV in the bloodstream and monitor CD4 cell counts, you just have a fevered patient losing weight with a mysterious red skin rash to deal with. How many of those has homeopathy fixed?

    Or breast cancer with spread to lymph nodes.

    Or macular degeneration.

    Or Type 1 diabetes.

    If you are going to start placing limitations on what homeopathy says it can cure then you’re going to have to reject an awful lot of your historical literature.

    I will accept that you are right in pointing out that “even extreme conditions have been recorded to have reversed for unkown reasons” so obviously we’d need to build up a decent set of such cases beyond what would be reasonable. My problem, though, is that list needs to start with its first item and you have not come up with that nor, it seems, has any other homeopath in the history of homeopathy. I wonder why.

  66. BSM said,

    November 27, 2007 at 11:06 pm

    p.s. of course I didn’t mention the MS again, I was rather embarrassed that you had brought it up since it is exactly the kind of chronically fluctuating condition that allows any quackery to make big claims. All you have to do is find a patient willing to let you treat them for long enough and in almost all cases you’ll get a remission phase and the chance to claim you were responsible for it in the insufferable way that homeopaths typically do.

    I would also say David, that having debated homeopaths of a number of years, I will commend you on at least making an effort and accepting the responsibility for trying to make your case.

  67. David / Homeopathy Zone said,

    November 29, 2007 at 9:43 am

    You are either ignorant of homeopathy (your level of knowledge seems that of someone who’s read a “consumer’s guide” about it), or you are deliberately caricaturing it:

    While pathology is not an important diagnostic factor — most of the time other, more specific symptoms will trump it in the hierarchy of important symptoms to consider — it is a crucially important prognostically, as the same symptom may be curable or not depending on pathological basis. In contemporary homeopathic practice the vast majority of patients have ben diagnosed and rediagnosed before ever arriving at homeopathy, whereas historically many homeopaths were MDs versed in the diagnostic tools of their day. For you to suggest that I have no right to refer to pathology is therefore ridiculous.

    Your claims about the AS and MS examples being easily explicable by other factors is baseless: I recognize that my case descriptions were brief, but they were enough to suggest that these were fairly severe cases. The AS patient was in a wheelchair and remained so for the first 2 years of treatment. The MS patient was also in a wheelchair with complete lower-body paralysis (not just weakness or spasticity) and her breathing was beginning to be compromised as the diaphragm was being threatened with paralysis — this is by any measure a severe case. Please provide case examples of remissions from these states rather than claim that they could easily happen. Likewise please provide examples of medical treatment leading to remission and decalcificaiton of a fused spine. The requirement for providing evidence falls on both parties.

    Given your craftiness, it is perfectly reasonable for me to request specific requirements for the sort of evidence you would like me to profer. It is interesting, for example, that you consider AIDS a non-self-limiting pathology but the cases I described are. Where do you get this division from? Do refer me to an evidence base.

    Anyway, my impression is that you are not in the business of “inference to the best explanation” but, just like Shang et al., are doing “inference to the best explanation of the phenomenon that excludes homeopathy”, which means you are not open to the possibility that the best explanation includes homeopathy as you consider it prima facie out-of-the-question. I therefore suggest that we end it here, unless I see an indication that you are willing actually to enter into a debate which you haven’t, thus far, entered.

  68. roGER said,

    November 30, 2007 at 10:09 am

    Thanks for both this article and the longer one, Ben.

    Very well written and you make excellent points.

    Thanks!

  69. CazA said,

    December 5, 2007 at 12:52 am

    BSM,

    i know you only asked for one, but i’m in a good mood, so here are 2 cured cases i found after a 2 minute google:

    graves disease:
    www.hpathy.com/casesnew/schepper-lachesis.asp
    .asp

    chronic pancreatitis (80% reduced function)
    www.hpathy.com/casesnew/barvalia-kali-iod.asp

    you’ll generally find the indian homeopaths have more cases of serious pathology than homeopaths in the uk (for obvious reasons).

    if you’d like more, there are plenty on the site above, plus i suggest you refer to the spring 07 edition of ‘The Homeopath’ (25:4) particulary Banerjea, ‘Pathology & Homeopathy’ pp122-125, which includes cases of cerebral atrophy & abdo tumour.

  70. DrJon said,

    December 5, 2007 at 8:16 am

    CazA: I’m afraid neither of those offer an incontrovertible example, for many of the reasons discussed above. They also do not qualify as scientific proof of any kind. For a description of scientific proof related to homeopathy, see Ben’s guardian article.

    What would it take to convince you homeopathy has no effect?

  71. DrJon said,

    December 5, 2007 at 10:33 pm

    So you admit that the cases you presented didn’t fulfil BSMs criteria? The “reason” you picked is obviously not any of the ones I was referring too.

    How do you conclude I have a closed mind? I am a doctor of philosophy, and will reconsider my opinion based on the evidence. You state that nothing could change your mind – is that the very definition of a closed mind?

    Also, why do you use the word allopathy? Doesn’t this show an inherent bias?

    I’m afraid your experience counts for nothing unless you have scientifically documented it and carried out properly conducted scientific studies.

    You have added nothing new to this debate and repeated the worn clichés that have already been addressed many times here and elsewhere.

    Why, if it so miraculous, does homeopathy score no better than placebo in all well conducted scientific studies? (Please don’t use quantum theory to support your arguments.)

  72. Acleron said,

    December 6, 2007 at 1:39 am

    Sorry late into this thread but fired up from another one.
    CazA uses the words allopathic, personally, dramatic. These can be powerful words but s/he doesn’t mention that a) there is no scientific reason why homeopathy should work and that there is good reasons why it shouldn’t and that b)there is no convincing clinical trial that shows it does work. Apart from trying to continue to make money from people why does anyone practice homeopathy?

  73. BSM said,

    December 7, 2007 at 4:10 pm

    David

    “For you to suggest that I have no right to refer to pathology is therefore ridiculous.”

    I’m afraid the subtlety of the point was lost on you.

    Perhaps you might like to produce me an example of a proving in which histologically confirmed end-stage renal fibrosis was produced by the remedy until consideration. Once you have done that then I will accept your point that conventional pathological descriptions of disease can have some meaningful part to play in your interventions.

    I’m afraid you have fallen into the trap along with all other homeopaths of apeing the mannerisms of conventional medicine in order to appear credible but without understanding that you cannot logically apply it by your own rules.

    That homeopaths do not understand their own philosophy and express mutually contradictory and internally contradictory versions of it is something I have seen time and again. The reason for this is that all of you are basically trading in fictions that do not intersect with the real world and can say anything you like without fear of contradiction because your approach to medical cases renders you incapable of forming valid judgements. Remember, homeopathy is just a set of excuses not a system of medicine.

    “You coudn’t ever convince me homeopathy has no effect as I have personally witnessed dramatic, immediate effects after giving homeopathic remedies, including on animals and babies, where placebo cannot possibly be an explanation.”
    You keep repeating this strawman. Please understand this once and for all. I think the place for placebo in most of homeopathic practice is vanishingly small. Most reported improvements are either coincidental or misrepresentations of the truth.

    The idea that the placebo effect may be important is a sop thrown to homeopaths to allow them to leave the field with a little dignity intact. If you had real effects then you would find it very easy to answer the question;

    GIVE ONE, YOU ONLY NEED ONE, INCONTROVERTIBLE EXAMPLE, WITH REFERENCES, OF HOMEOPATHY CURING A NON-SELF-LIMITING CONDITION.

    The fact that you can’t even come up with a half answer should tell you something.

    But if you’d like a specific example to narrow the field, show me a cure of AIDS or metastatic melanoma or end-stage renal failure or Type 1 diabetes or Addison’s disease or rabies.

  74. BSM said,

    December 7, 2007 at 4:18 pm

    “In fact, regards the much touted theory that homeopathy is nothing but placebo, I have always wondered why patients who have been failed by allopathic medicine, and who have tried other alternatives before they finally get to homeopathy, suddenly report feeling better. If they are so prone to suggestion, why didn’t they get better after allopathic treatment or the previous therapies they tried? Do they get to the homepath’s consulting room and suddenly come over all gullible?”

    As I have just pointed out to David, no one is claiming that the effects of homeopathy are all placebo. There is probably a modest placebo effect in some illnesses but not in the majority of significant physical medical conditions. The idea that it is all placebo effect is merely a cover to allow you to hide the real mendacity of the homeopathic community. No, the real processes behind most homeopathic tales of successes are simply lies or misunderstanding of the natural history of disease so that coincidental changes are reported as success for homeopathy or real outcomes are concealed or justified by one of the set of excuses that homeopathy provides.

    If you are a homeopath, will you have the honesty to tell us whether you have ever cured a major physical disease or whether you piddle around with trivial lifestyle conditions like most homeopaths and/or piggyback your practice on the expectation that asthma or eczema or irritable bowel syndrome will fluctuate into improvement phases for which you an claim credit?

  75. David / Homeopathy Zone said,

    December 8, 2007 at 11:14 am

    BSM,

    Your point about pathology being produced in provings shows that you are ignorant of the fact that the remedy picture is not merely made up of the proving (again, this is the “consumer’s guide” first-approximation explanation), but also on toxiocological data where available, and also on cured cases thereafter.

    I’ve earlier given examples of what should be considered impressive results, which you dismissed without providing the criteria on which you based your dismissal. Another reader provided examples that were likewise dismissed by someone else.

    Yes, there is a small number of cures of rabies in the homeopathic literature, which are available to all for inspection. I don’t, however, see the point of presenting them to you only for them to be dismissed as fraudulent, misdiagnoses, etc.

    As I’ve mentioned above, you already know the truth even though you are obviously ignorant of the clinical reality of homeopathy, and so there is no point in furthering our debate.

  76. markgdavis said,

    December 11, 2007 at 9:30 am

    BSM, Ben, and David,
    I’m a second-year student of naturopathic medicine in Portland, Oregon, USA. Just so you know, the ND degree confers the same prescriptive rights as the MD degree in several states, so the education involves just as much science–graduate level biochemistry, histology, pathology, microbiology, etc.
    Part of the required coursework at my school is 4 or 5 quarters of homeopathy, and I’ve just finished the first quarter.
    Now, I’m perfectly willing to believe that homeopathy is complete hogwash, and stick to remedies like pharmaceuticals, nutritional advice, botanical medicine, counseling, etc.
    But as far as I’ve seen, the evidence weighs in on the side of the homeopaths. The Linde and Kleijnen meta-analyses cited by Ben show efficacy for homeopathy, so it’s really weird that the opening paragraph of the Lancet article cites them as indicating that “homoeopathy produced no statistically
    significant benefit over placebo”. I wasn’t able to find the abstracts for the Boissel and Cucherat, but the comments by David (and the ones he cited by Linde) about the Shang study make that a questionable source for me.
    If you want peer reviewed studies, I reference four in comment #26 above, which I was a little disappointed that no-one responded to. And I could throw more your way if you’re really interested.
    If you want individual cases, come on, don’t ask for cures of type I diabetes or end stage renal failure. I mean, I’m going to be a doctor, and I want to evaluate whether I can use pharmaceuticals or nutritional advice or homeopathy, etc. to fix somebody, and y’know, I just don’t think any of those things will fix someone’s type I diabetes. But can nutritional advice help them control their symptoms? Yeah! can pharmaceuticals or homeopathy help their lives? Maybe.
    The only criticism that really makes me question homeopathy is the idea that publication bias may have lead to a statistically inevitable number of false positive studies, but that’s far from a searing condemnation… more like a suggestion that you should be careful when building up your beliefs using peer reviewed studies as your guide.
    As of right now, I imagine that when I graduate, I’ll be inclined to try homeopathy when my patients are kids with diarrhea, or arthritis or rhinitis sufferers. Or, for that matter, kids with otitis media, which I hear I’ll probably see a lot.
    If anyone can tell me why to disregard the studies cited above, or why to think weak statistical significance for efficacy translates to no significant benefit, I honestly could be swayed from using homeopathy.
    I really hope to hear from someone, and thanks for all the eloquent criticism of and support for homeopathy that I’ve heard so far.

  77. BSM said,

    December 17, 2007 at 4:04 pm

    markgdavis said

    Now, I’m perfectly willing to believe that homeopathy is complete hogwash, and stick to remedies like pharmaceuticals, nutritional advice, botanical medicine, counseling, etc.

    I think you mean imperfectly. :-)

    Linde revised his findings, but the homeopaths only quote the 1997 version with flawed results not the revision. Both Linde and Kleijnen at best offer very weak support for homeopathy which basically says any effects are lost in the statistical noise and this is what we would expect for a placebo not what we would expect for this allegedly all-conquering therapeutic system.

    If you want individual cases, come on, don’t ask for cures of type I diabetes or end stage renal failure.

    I think you have just disqualified yourself from comment. Let me remind you that homeopathy originated in a world in which no such diagnoses could have been made. All the homeopath would have would be the symptoms the patient told him about. So, we now might be able to determine that the patient has cirrhosis, but the homeopath would only have seen ‘dropsy’ and ‘jaundice’. As I said to David previously, you as a homeopath are disallowed modern medical diagnostic methods. If you insist on acting in accordance with modern diagnoses then you must reject as utter fiction the vast bulk of your historical case records. Why? Because historical homeopaths were treating just these end-stage patients that modern medicine can accurately describe but reporting alleged successes regardless. This, if any more was needed, should tell you that the homeopathic literature is just a work of the human imagination, having no more bearing on real medicine than astrology.

    I would remind you that homeopathy is supposed to be a “complete system of medicine” not a system restricted to dealing in trivia.

    As of right now, I imagine that when I graduate, I’ll be inclined to try homeopathy when my patients are kids with diarrhea, or arthritis or rhinitis sufferers. Or, for that matter, kids with otitis media, which I hear I’ll probably see a lot.

    So no danger of having your prejudices and preconceptions challenged. That’s just hopeless.

    So, you’ll take money for treating self-limiting conditions that fluctuate or resolve spontaneously. Very honourable. Not.

    David said;

    Yes, there is a small number of cures of rabies in the homeopathic literature, which are available to all for inspection

    OK, then cite one properly documented case. Unless you can do that I shall file this along with the other Big Fat Lies that have to be told to keep homeopathy’s show on the road.

    Your point about pathology being produced in provings shows that you are ignorant of the fact that the remedy picture is not merely made up of the proving (again, this is the “consumer’s guide” first-approximation explanation), but also on toxiocological data where available, and also on cured cases thereafter.

    Forgive me, but that is just utter bollocks. Even if it were not close to being a literal untruth, it would still be bollocks, because accumulating ‘cured cases’ in the completely non-systematic way of homeopaths is no evidence of anything. This is your whole problem. You think you have this marvellous secure evidence base but are so blinkered in your belief that you cannot see it has been knitted from fog.

    Where is the toxicological data for “Light of Venus” or “Peregrine Falcon”? Pull the other one, it has bells on it- being an attractive English idiomatic phrase expressingly cynical disbelief.

  78. BSM said,

    December 18, 2007 at 7:50 am

    markgdavis said

    If you want peer reviewed studies, I reference four in comment #26 above, which I was a little disappointed that no-one responded to.

    Which werel;

    RCTs I’ve read that show efficacy for homeopathy include:
    Jacobs et al, “Treatment of Acute Childhood Diarrhea with Homeopathic Medicine: A Randomized Clinical Trial in Nicaragua,” Pediatrics, Volume 93, Number 5, pp. 714-725 (May 1994)
    Jacobs et al., “Homeopathic Treatment of Acute Childhood Diarrhea: Results from a Clinical Trial in Nepal,” Journal of Alternative and Complementary Medicine, Volume 6, pp. 131-139 (2000)
    Gibson et al., “Homoeopathic Therapy in Rheumatoid Arthritis: Evaluation by Double-Blind Clinical Therapeutic Trial,” British Journal of Clinical Pharmacology, 9, pp. 453-459 (1980)
    Taylor et al., “Randomised controlled trial of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series,” British Medical Journal, 321, pp. 471-476 (19 August 2000)

    All rubbish. Badly defined end-points. Badly designed controls. All the usual things.

  79. BSM said,

    December 19, 2007 at 1:01 pm

    David, I’m afraid you are just being silly and raising strawman arguments.

    1. We know the homeopathic literature is untrustworthy, but I don’t expect it contains many outright lies. If you can come up with a properly documented case record of the type I have described then it would be interesting. So far you have not even made the attempt.

    2. I dismiss your first hand evidence as unimpressive because it is unimpressive and conforms to a standard pattern: the homeopath one is talking to only has rather feeble cases available, but they’re sure they’ve heard of someone or read something once that should a really dramatic cure of cancer/rabies/AIDS (delete as appropriate).

    3. I have not dismissed articles in mainstream journal without proper argument. Give me one example, where you have read the full-text and are prepared to defend it and I will go through that paper with you, but bear in mind that the lesson of the meta-analyses has been that no homeopathic papers exist which can bear proper scrutiny or are anything other than statistical anomalies. But, please feel free to look for one.

    4. This point requires an understanding of the statistics at play in these papers. The point I was making, however is that homeopathy claims strong reliable real effects in patients. The mere fact of having to hunt for tiny effects in the statistical noise disproves the main claims of homeopathy. For instance, one of the papers of Oscillococcinum did manage to find a p value of “So, I see no reason not to present you with a requirement to come up with a homeopathic cure for something like cirrhosis of the liver. After all, in Hahnemann’s day that would have been a patient suffering dropsy, lethargy and fatty pallid stools.
    Or how about AIDS. Homeopathy has no place for the germ-theory of infection, so it makes no difference to you whether we can measure HIV in the bloodstream and monitor CD4 cell counts, you just have a fevered patient losing weight with a mysterious red skin rash to deal with. How many of those has homeopathy fixed?
    Or breast cancer with spread to lymph nodes.
    Or macular degeneration.
    Or Type 1 diabetes.
    If you are going to start placing limitations on what homeopathy says it can cure then you’re going to have to reject an awful lot of your historical literature.”

    I will repeat again that it is only since the advent of modern medicine that the clinical syndromes and symptom-pictures with which such patients present would lead to an untreatable conventional diagnosis. Patients always had these diseases we just didn’t have the means to apply the current set of labels to them. Throughout homeopathy’s history these patients would simply have received remedies targeted at the symptoms. So, I specifically do not allow you to shy away from diseases that conventional medicine calls ‘untreatable’. Homeopaths pretend to treat AIDS and cancer, it would be futile for you to deny this. So, please come up with a properly documented case, or learn something from your inability to do so.

    David, I have spent years honestly evaluating the evidence advanced by homeopaths. All I have found have been misrepresentations, lies, confusion and mainly badly designed studies. I have found some good studies: these are negative. There have been a number of attempted provings done under properly controlled conditions rather than the joke protocols that homeopaths usually call controlled. These have been done by homeopaths. Look these up. They have all been failures. Why? Because homeopathic “provings” are works of the imagination not recordings of genuine facts.

    Here’s a short list. All done by homeopaths. The failures by Harald Walach seem to have driven him to declaring that homeopathy works by magic at which point homeopathy and reality finally part company for the last time.

    Brien et al Ultramolecular homeopathy has no observable clinical effects. A randomized, double-blind, placebo-controlled proving trial of Belladonna 30C B J C Pharm, 56, 562-568. (2003)

    Walach et al The effects of homeopathic belladonna 30CH in healthy volunteers – a randomized, double-blind experiment. J Psychosom Res 50 155-160. (2001)

    Vickers et al Can homeopathically prepared mercury cause symptoms in healthy volunteers? A randomized, double-blind placebo-controlled trial. J Alt Comp Med. 7 141-8. (2001)

    Goodyear et al Randomized double-blind placebo-controlled trial of homoeopathic ‘proving’ for Belladonna C30. J R Soc Med 91 579-82. (1998)

    Walach Does a highly diluted homeopathic drug act as a placebo in healthy volunteers? Experimental study of Belladonna 30C in a double blind crossover design – a pilot study. J Psychosom Res 37 851-860. (1993)

    This is your literature, David, you should have been familiar with it.

    You are a young man with a long career ahead of you. Go and do something useful with your life instead of wasting it on the pack of lies that is homeopathy. It’s a big interesting world out there. All homeopathy does is force you to view it through distorting lenses. That is not healthy and it is a sad waste of one’s life, which may be why we see such desperation when it is challenged.

  80. David / Homeopathy Zone said,

    December 19, 2007 at 7:49 pm

    BSM,

    I appreciate your genuine concern for my homeopathic soul. I guess I will have to keep living in my alternate reality, helping people not helped by those living in your vastly superior one (I love to catch all of those regressions to the mean just in time; evidently the medical community has less talent in this game).

    You have still not given me the incontrovertible criteria that you so adamantly demand. Evidently they cannot be produced, and it is therefore not surprising that in all your years of demanding them they haven’t been satisfied, as they couldn’t be even if homeopathy were real.

    As far as I can tell, you don’t seem to have, in all your years of evaluating homeopathy, spent appreciable time in a clinical setting with a senior homeopath and engaged in long-term observation of chronic cases — as I said this is the only way that a die-hard skeptic would potentially be able to gather the necessary evidence to perturb one’s conviction. Then you might have remained skeptical, but you would have had other, far more concrete and convincing reasons on which to base your case, as opposed to the theoretical dismissals that you keep offering.

    Regarding studies, your confident pronouncements (whereby you parse studies for quality by their conclusions) are simply ludicrous. They are nothing more than a personal reading in the spirit of Shang et al.: “I will assume that all positive results could be explained as [insert criticism here]“. You are obviously not open to a chain of reasoning in which the consequence is yet-undetermined, as yours is predetermined.

    I will end my participation in this thread here; feel free to add a coup de grace.

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  83. MHodges said,

    December 2, 2013 at 12:37 am

    [sigh] yet another sad piece of evidence rolling in countering the myth of the ‘harmlessness’ of homeopathy (via Stephen Barrett’s post in Consumer Health Digest today):

    “Mother of dead boy arrested for avoiding medical care-
    Tamara Lovett, of Calgary, Canada, whose 7-year-old son Ryan died last March from a medically treatable streptococcal infection, has been charged with criminal negligence and failure to provide the necessaries of life. Press reports state that Lorett had never taken him to a doctor, had a belief system in homeopathy, and had used “holistic remedies” to treat the infection even though Ryan was bedridden for ten days and looked very ill. [Schmidt C. Calgary mother arrested in death of young son. CTV News, Nov 22, 2013]”

    Read more: calgary.ctvnews.ca/calgary-mother-arrested-in-death-of-young-son-1.1555943#ixzz2mH0Kjq1u

    “…but there was a belief system in homeopathic medicine that did factor in.”

    ###

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